NPIMap

Individual provider Active NPI

Timothy Scott Ulleseit, PA-C

  • Physician Assistant
  • Los Gatos, CA
National Provider Identifier
1245851120
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
64326 Issued in CA
Practice address
15425 Los Gatos Blvd Ste 120
Los Gatos, CA 95032-2541
Phone
(408) 340-5700
NPI assigned
May 1, 2020
Last updated
Nov 18, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA207110 OR
Physician Assistant 363A00000X 64326 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

15425 Los Gatos Blvd Ste 120
Los Gatos, CA 95032-2541

Mailing address

15425 Los Gatos Blvd Ste 120
Los Gatos, CA 95032-2541
Phone (408) 340-5700

Other practice location 1

2730 South Moody Ave
Portland, OR 97201
Phone (503) 494-3633

Other practice location 2

2821 Daggett Ave Ste 100
Klamath Falls, OR 97601-1130
Phone (541) 274-6733

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20211208001823 OR Practitioner - Physician Assistant 6002206984 Reassigns benefits to 1 organization
I20240930002895 CA Practitioner - Physician Assistant 6002206984 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Oregon Health Sciences University School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Healthcare AllianceGroup PAC ID 6305748799, 334 clinicians

Practice addresses (Care Compare)

1300 Crane St
Menlo Park, CA 94025-4260
Phone (650) 498-6500

15425 Los Gatos Blvd
Suite 120
Los Gatos, CA 95032-2541
Phone (408) 340-5700

20642 John Dr
Castro Valley, CA 94546-5103
Phone (888) 924-1036

4725 1St St
Suite 100
Pleasanton, CA 94566-7366
Phone (925) 462-7060

50 E Hamilton Ave
Suite 280
Campbell, CA 95008-0273
Phone (408) 227-2646

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
64326CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Sky Lakes Medical Center Inc CurrentSince Nov 30, 2021 Accepting new patients
Affinity Medical Group Past Accepting new patients

Locations

2821 Daggett Ave
Ste 100
Klamath Falls, OR 97601
Phone (541) 274-4611

2821 Daggett Ave
Ste 200
Klamath Falls, OR 97601
Phone (541) 274-8400

2865 Daggett Ave
Klamath Falls, OR 97601
Phone (541) 833-6221

Interoperability endpoints

  • Direct secure messaging: tulleseit508702@direct.stanfordhealthcare.org

Organizations & group practices 3

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 8

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": "1588291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1245851120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15425 LOS GATOS BLVD STE 120",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950322541",
            "telephone_number": "408-340-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15425 LOS GATOS BLVD STE 120",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950322541",
            "telephone_number": "408-340-5700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2730 South Moody Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "97201",
            "country_code": "US",
            "telephone_number": "503-494-3633",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2821 Daggett Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Klamath Falls",
            "state": "OR",
            "postal_code": "976011130",
            "country_code": "US",
            "telephone_number": "541-274-6733",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ULLESEIT",
        "first_name": "TIMOTHY",
        "middle_name": "SCOTT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-01",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA207110",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "64326",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Gatos, CA

Sources for this page

Verify at the official NPI Registry.