NPIMap

Individual provider Active NPI

Kalle Marc Stidham, D.O.

  • Orthopaedic Surgery Physician
  • San Jose, CA
National Provider Identifier
1164627501
Registry record updated Apr 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
20A10063 Issued in CA
Practice address
550 S Winchester Blvd
Suite 100
San Jose, CA 95128-2544
Phone
(650) 851-4900
Fax
(408) 556-8415
NPI assigned
Jun 17, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 20A10063 CA Primary

Addresses

Primary practice location

550 S Winchester Blvd
Suite 100
San Jose, CA 95128-2544

Mailing address

500 Arguello St
Suite 100
Redwood City, CA 94063-1566
Phone (650) 851-4900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091207000012 CA Practitioner - Orthopedic SurgeryPractitioner - Sports Medicine 8325112428 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic SurgeryAlso: Sports Medicine
Education
Other, 2002
Medicare assignment
May accept Medicare assignment
Group practices
Dr Morteza Farr DO IncGroup PAC ID 4183809387, 2 clinicians
James Petros MD IncGroup PAC ID 0941479216, 21 clinicians
Advanced Surgical AssociatesGroup PAC ID 2567438849, 6 clinicians

Practice addresses (Care Compare)

1144 Norman Dr
Suite 104
Manteca, CA 95336-5959
Phone (209) 456-5516

1604 Blossom Hill Rd
Suite 10
San Jose, CA 95124-6350
Phone (408) 528-8833

200 Jose Figueres Ave
Suite 225
San Jose, CA 95116-1588
Phone (408) 929-5610

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Knee replacement1-10
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)33
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
10063CAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
James Petros, M.D., Inc. Current Accepting new patients
James Petros, M.D., Inc. CurrentSince Apr 24, 2025 Accepting new patients
James Petros, M.D., Inc. CurrentSince Apr 24, 2025 Accepting new patients
County of Santa Clara Past Accepting new patients
El Camino Hospital Past Accepting new patients
Sequoia Health Services Past Accepting new patients
The Physiatry Medical Group, Inc Past Accepting new patients
Good Samaritan Hospital, L.P. Past Accepting new patients

Locations

14777 Los Gatos Blvd
Ste 202
Los Gatos, CA 95032
Phone (408) 528-8833

1604 Blossom Hill Rd
Ste 10
San Jose, CA 95124
Phone (408) 528-8833

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 10

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1182038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461283200000",
    "number": "1164627501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 ARGUELLO ST",
            "address_2": "SUITE 100",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940631566",
            "telephone_number": "650-851-4900",
            "fax_number": "650-995-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 S WINCHESTER BLVD",
            "address_2": "SUITE 100",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282544",
            "telephone_number": "650-851-4900",
            "fax_number": "408-556-8415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STIDHAM",
        "first_name": "KALLE",
        "middle_name": "MARC",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-17",
        "last_updated": "2016-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "20A10063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.