Jill Kathleen Pavliscak, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A104908 Issued in CA

Practice address

575 Kelly St
Half Moon Bay, CA 94019-1719

Phone

(650) 560-0216

Fax

(560) 295-0397

NPI assigned

Jun 30, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Oregon Health Sciences University School of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Purisima Family Medicine, Inc.Group PAC ID 6800942533, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sutter Care at Home Home health agency, San Mateo, CA, CCN 058123
• Peninsula Medical Center Hospital, Burlingame, CA, CCN 050007

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jpavliscak50734@hisp.ehr.sutterhealth.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Purisima Family Medicine, Inc.

  • Family Medicine Physician
  • Half Moon Bay, CA
  • NPI 1881821387
  Medicare reassignment Care Compare group NPD
• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Burlingame, CA
  • NPI 1043670334
  NPD (past)
• Sutter East Bay Medical Foundation

  • Family Medicine Physician
  • Orinda, CA
  • NPI 1871538769
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Burlingame, CA
  • NPI 1043670334
  Care Compare affiliation
• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Menlo Park, CA
  • NPI 1295199701
  Care Compare affiliation
• Sutter Visiting Nurse Association and Hospice

  • Home Health Agency
  • San Mateo, CA
  • NPI 1821027624
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339545600000",
    "number": "1144258765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 KELLY ST",
            "city": "HALF MOON BAY",
            "state": "CA",
            "postal_code": "940191719",
            "telephone_number": "650-560-0216",
            "fax_number": "650-295-0397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 KELLY ST",
            "city": "HALF MOON BAY",
            "state": "CA",
            "postal_code": "940191719",
            "telephone_number": "650-560-0216",
            "fax_number": "560-295-0397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAVLISCAK",
        "first_name": "JILL",
        "middle_name": "KATHLEEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2012-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A104908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3459501",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elida B Oettel, LCSW
• Charles Onubogu
• Vanessa Marie Oppenlander, MD
• Michael Dale Osborne, MD
• Lorraine R Page, M.D.
• Rose Pendleton, MA
• Deborah B Penrose, DO
• Sandra Lynn Perez, NP
• Emma Petree
• Khoa Dang Pham, RPH

• Family Medicine Physician in Half Moon Bay, CA
• Providers in Half Moon Bay, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.