Individual provider Active NPI

John A. Connolly, M.D.

  • Urology Physician
  • Burlingame, CA
National Provider Identifier
1174529309
Registry record updated Jun 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
A56059 Issued in CA
Practice address
1750 El Camino Real
Suite #307
Burlingame, CA 94010
Phone
(650) 259-1480
Fax
(650) 697-7361
NPI assigned
Jun 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X A56059 CA
Urology Physician 208800000X A56059 CA Primary

Addresses

Primary practice location

1750 El Camino Real
Suite #307
Burlingame, CA 94010

Mailing address

325 Distel Cir
Los Altos, CA 94022-1408
Phone (650) 652-7015

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ83789ZMedicaidCA

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20081024000173 CA Practitioner - Urology 5496822827 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, shared by 16 NPIs, 3,783 clinicians

Practice addresses (Care Compare)

100 S San Mateo Dr
San Mateo, CA 94401-3805
Phone (650) 696-5400

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

1501 Trousdale Dr
Burlingame, CA 94010-4506
Phone (650) 696-5400

795 El Camino Real
Palo Alto, CA 94301-2302
Phone (415) 600-1020

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A56059CAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation CurrentSince Jan 6, 2020 Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jan 6, 2020 Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jan 6, 2020 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jan 6, 2020 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jan 6, 2020 Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Sutter Bay Medical Foundation CurrentSince Jan 6, 2020 Accepting new patients
Sequoia Health Services Past Accepting new patients
Seton Medical Center Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients

Locations

18400 US Highway 18
Apple Valley, CA 92307
Phone (760) 810-7590

1501 Trousdale Dr
Fl 2
Burlingame, CA 94010
Phone (650) 652-8310

1750 El Camino Real
Ste 307
Burlingame, CA 94010
Phone (650) 259-1480

1501 Trousdale Dr
Burlingame, CA 94010
Phone (650) 696-3520

1950 University Ave
Ste 160
East Palo Alto, CA 94303
Phone (650) 317-8100

3120 Kearney St
Fremont, CA 94538
Phone (650) 498-3600

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

370 Distel Cir
Los Altos, CA 94022
Phone (650) 254-5200

325 Distel Cir
Los Altos, CA 94022
Phone (510) 204-3977

715 Altos Oaks Dr
Los Altos, CA 94024
Phone (650) 934-7010

600 Coffee Rd
Modesto, CA 95355
Phone (209) 550-4755

701 E El Camino Real
#1
Mountain View, CA 94040
Phone (650) 404-8440

101 Rowland Way
Ste 220
Novato, CA 94945
Phone (415) 878-7200

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 324-1832

795 El Camino Real
#1112
Palo Alto, CA 94301

151 N Sunrise Ave
Ste 1205
Roseville, CA 95661
Phone (916) 789-1505

301 Industrial Rd
#1
San Carlos, CA 94070
Phone (650) 404-8455

3838 California St
Rm 410
San Francisco, CA 94118
Phone (415) 751-1847

2581 Samaritan Dr
Ste 308
San Jose, CA 95124
Phone (408) 355-1700

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

3883 Airway Dr
Ste 220
Santa Rosa, CA 95403
Phone (707) 521-7750

10200 Trinity Pkwy
Ste 101
Stockton, CA 95219
Phone (209) 323-3488

550 S Green Valley Rd
Watsonville, CA 95076
Phone (831) 458-5865

Interoperability endpoints

  • Direct secure messaging: jconnolly48055@hisp.ehr.sutterhealth.org

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 2

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": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592870400000",
    "number": "1174529309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 DISTEL CIR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940221408",
            "telephone_number": "650-652-7015",
            "fax_number": "650-697-7361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 EL CAMINO REAL",
            "address_2": "SUITE #307",
            "city": "BURLINGAME",
            "state": "CA",
            "postal_code": "94010",
            "telephone_number": "650-259-1480",
            "fax_number": "650-697-7361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "JOHN",
        "middle_name": "A.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A56059",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "A56059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ83789Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlingame, CA

Sources for this page

Verify at the official NPI Registry.