NPIMap

Organization Active NPI

Bay Area Pediatric Medical Group Inc

  • Pediatrics Physician
  • Daly City, CA
National Provider Identifier
1164697090
Registry record updated Apr 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
BAY AREA PEDIATRIC MEDICAL GROUP INC
Practice address
1500 Southgate Ave Ste 213
Daly City, CA 94015-2231
Phone
(650) 994-1800
Fax
(650) 994-1888
NPI assigned
Apr 22, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2008

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

Authorized official

Name
Donna Oconnell
Title
Manager Business Office
Phone
(650) 994-1800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X CA Primary

Addresses

Primary practice location

1500 Southgate Ave Ste 213
Daly City, CA 94015-2231

Mailing address

123 S San Mateo Dr
San Mateo, CA 94401-3804
Phone (650) 343-4200

Other identifiers 1

IdentifierTypeStateIssuer
GR0081923MedicaidCA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1164697090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 S SAN MATEO DR",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013804",
            "telephone_number": "650-343-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 SOUTHGATE AVE STE 213",
            "city": "DALY CITY",
            "state": "CA",
            "postal_code": "940152231",
            "telephone_number": "650-994-1800",
            "fax_number": "650-994-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY AREA PEDIATRIC MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-22",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "OCONNELL",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "MANAGER BUSINESS OFFICE",
        "authorized_official_telephone_number": "650-994-1800"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0081923",
            "state": "CA"
        }
    ],
    "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 Apr 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.