Peninsula Orthopedic Associates, Inc.
Organization Active NPI Orthopaedic Surgery Physician · Daly City, CA
NPI 1154464329 · NPPES record last updated Nov 18, 2008
Key facts
- NPI
- 1154464329
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- Legal business name
- PENINSULA ORTHOPEDIC ASSOCIATES, INC.
- Practice address
- 1850 Sullivan Ave Ste 330
Daly City, CA 94015-2204 - Phone
- (650) 756-5630
- Fax
- (650) 994-1155
- NPI assigned
- Feb 15, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Stephen Conrad, M.D.
- Title
- President
- Phone
- (650) 756-5630
Practitioners 23
-
Bryant E Bonner, MD
-
Edgar Gabriel Celis, M.D.
-
Penny Goumenidis, PA-C
-
Angela Cricchio Hull, DNP
-
Carri A Jones, MD
-
Aman Shabi Khan, MD
-
Leslie H. Kim, M.D.
-
Laura N Sciaroni, MD
-
Vinson Tan, PT, DPT
-
Olivia Ashley, PT
-
Rehan Khan, PAC
-
Carol Marraccini-Otto, PA-C
-
James B Reynolds, MD
-
Joshua Dagcuta, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040427000616 | CA | Part B Supplier - Clinic/Group Practice | 7719974336 |
Receives reassigned benefits from 20 practitioners Practice locations: Daly City, CA; Los Gatos, CA; Menlo Park, CA |
| O20100930017917 | CA | DME Supplier - Physician - Orthopedic/Orthopedic Surgery | 7719974336 | Practice locations: Daly City, CA |
National Provider Directory
Locations
1800 Sullivan Ave
Rm 307
Daly City, CA 94015
Phone (650) 756-5630
455 Hickey Blvd
Ste 205
Daly City, CA 94015
Phone (650) 746-3299
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician |
207X00000X | Yes | ||
| Durable Medical Equipment & Medical Supplies | 332B00000X | 0208450001 | CA |
Addresses
Primary practice location
1850 Sullivan Ave Ste 330
Daly City, CA 94015-2204
Mailing address
1850 Sullivan Ave Ste 330
Daly City, CA 94015-2204
Phone (650) 756-5630
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0053110 | Medicaid | CA |
Other providers in Daly City, CA
- Dakota Pehling
- Liliana Peixotto
- Pem Comfort Care, LLC
- Peninsula Anesthesia Consultants Inc
- Peninsula Hand Therapy, Inc.
- Peninsula Pulmonary
- Jennifer Peralta
- Joseph Perez Alvarez
- Norma Aracely Perez
- Perpetua Madrilejo Dental Office Inc.
All providers in Daly City, CA · Orthopaedic Surgery Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.