NPIMap

Organization Active NPI

Peninsula Orthopedic Associates, Inc.

  • Orthopaedic Surgery Physician
  • Daly City, CA
National Provider Identifier
1154464329
Registry record updated Nov 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 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
Last updated
Nov 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2008

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

Authorized official

Name
Dr. Stephen Conrad, M.D.NPI 1588670186
Title
President
Phone
(650) 756-5630

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary
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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

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

901 Campus Dr
Ste 107
Daly City, CA 94015

15047 Los Gatos Blvd
Ste 100
Los Gatos, CA 95032
Phone (408) 356-2774

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226966400000",
    "number": "1154464329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 SULLIVAN AVE STE 330",
            "city": "DALY CITY",
            "state": "CA",
            "postal_code": "940152204",
            "telephone_number": "650-756-5630",
            "fax_number": "650-994-1155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 SULLIVAN AVE STE 330",
            "city": "DALY CITY",
            "state": "CA",
            "postal_code": "940152204",
            "telephone_number": "650-756-5630",
            "fax_number": "650-994-1155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA ORTHOPEDIC ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2008-11-18",
        "status": "A",
        "authorized_official_last_name": "CONRAD",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "650-756-5630",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "0208450001",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Daly City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.