NPIMap

Individual provider Active NPI

Robert S Nishime, MD

  • Sports Medicine (Family Medicine) Physician
  • San Jose, CA
National Provider Identifier
1225087984
Registry record updated Jul 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
A62708 Issued in CA
Practice address
280 Jackson St
San Jose, CA 95112-3256
Phone
(408) 293-5864
NPI assigned
May 9, 2006
Last updated
Jul 26, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X A62708 CA Primary

Addresses

Primary practice location

280 Jackson St
San Jose, CA 95112-3256

Mailing address

900 Lafayette St Ste 105
Santa Clara, CA 95050-4966
Phone (408) 293-7767

Other identifiers 1

IdentifierTypeStateIssuer
00A627080MedicaidCA

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
I20040113000317 CA Practitioner - Family PracticePractitioner - Sports Medicine 7911807110 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Rush Medical College of Rush University, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Robert S Nishime MD IncGroup PAC ID 2961407564, 2 clinicians

Practice addresses (Care Compare)

280 Jackson St
San Jose, CA 95112-3256
Phone (408) 293-5864

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions26
Removal or shaving of skin growth17

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
South Bay Sports and Preventive Medicine Associates, Inc. CurrentSince Jun 1, 2016 Accepting new patients
County of Santa Clara Past Accepting new patients
El Camino Hospital Past Accepting new patients
Good Samaritan Hospital, L.P. Past Accepting new patients
Precision Orthopaedic Specialties, Inc. Sports Medicine Past Accepting new patients
O'Connor Hospital Past Accepting new patients

Locations

2250 Hayes St
Ste 208
San Francisco, CA 94117
Phone (415) 259-4101

280 Jackson St
San Jose, CA 95112
Phone (408) 293-5864

900 Lafayette St
Ste 105
Santa Clara, CA 95050
Phone (408) 556-8407

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: robert.nishime@214572301025284.direct.elationemr.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564099200000",
    "number": "1225087984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 LAFAYETTE ST STE 105",
            "city": "SANTA CLARA",
            "state": "CA",
            "postal_code": "950504966",
            "telephone_number": "408-293-7767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 JACKSON ST",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951123256",
            "telephone_number": "408-293-5864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISHIME",
        "first_name": "ROBERT",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-09",
        "last_updated": "2019-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "CA",
            "license": "A62708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A627080",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.