NPIMap

Organization Active NPI

Stanford Health Care

  • Psychiatric Hospital
  • Stanford, CA
National Provider Identifier
1265581086
Registry record updated Oct 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
070000662 Issued in CA
Legal business name
STANFORD HEALTH CARE
Practice address
300 Pasteur Dr
Stanford, CA 94305-2200
Phone
(650) 723-4000
NPI assigned
Jan 10, 2007
Last updated
Oct 30, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
STANFORD HEALTH CAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 30, 2019

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

Authorized official

Name
Ms. Fatana Amin-Abassi
Title
Provider Enrollment Manager
Phone
(510) 974-8592

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 070000662 CA Primary

Addresses

Primary practice location

300 Pasteur Dr
Stanford, CA 94305-2200

Mailing address

300 Pasteur Dr
Stanford, CA 94305-2200
Phone (650) 723-4000

Other identifiers 17

IdentifierTypeStateIssuer
001188115MedicaidNV
1288115MedicaidNV
HS810PMedicaidAS
7102213MedicaidWA
000A0561MedicaidNM
807248900MedicaidID
HS811PMedicaidAR
ZZZA4309ZOtherCABLUE SHIELD OF CA
092494300MedicaidFL
940057626MedicaidCO
034512MedicaidOR
050411MedicaidTX
244848MedicaidHI
010207789MedicaidVA
116853300MedicaidWY
635477MedicaidAZ
HSM00441HMedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070212000360 CA Part A Provider - Hospital 6709797491 Practice locations: Stanford, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265581086. Details of each certification follow.

Hospital certification: CCN 05S441

Legal name
STANFORD HEALTH CARE
Doing business as
STANFORD HEALTH SERVICES
Organization structure
CorporationNon-profit
Incorporated
Apr 12, 1957 in CA
Enrollment address
300 Pasteur Dr
Stanford, CA 94305-2200
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Stanford Medical Center50 organizations share this tax ID, including this one
Part of
Stanford Medical Center

Other organizations with this tax ID 49

Organizations that report the same tax identification number in the National Provider Directory.

View all 49

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 27

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lloyd Brooks Minor Individual Corporate OfficerDean, School of Medicine Aug 12, 2013
W-2 Managing Employee Dec 1, 2012
Mindy Rogers Individual Corporate OfficerBoard Member Nov 1, 2018
Mary T Hawn Individual Corporate OfficerBoard Member Jan 1, 2020
Chandler Evans Individual Corporate OfficerBoard Member Jan 1, 2014
Lata Krishnan Individual Corporate OfficerBoard Member Apr 1, 2018
Sanjay Mehrotra Individual Corporate OfficerBoard Member Jan 1, 2018
Jill Buathier Individual Corporate OfficerAuthorized Official Dec 1, 2018
W-2 Managing Employee Aug 12, 2013
Hamid R Moghadam Individual Corporate OfficerBoard Member Sep 1, 2021
Kavitark R Shriram Individual Corporate OfficerBoard Member Sep 1, 2019
Robert T Santos Individual Corporate OfficerBoard Member Jan 1, 2021
Jeffrey J Rothschild Individual Corporate OfficerBoard Member Jan 1, 2021
Mark Leslie Individual Corporate OfficerBoard Member Sep 1, 2015
Paul King Individual Corporate OfficerBoard Member Jan 1, 2022
Megan Ruth Mahoney Individual Corporate OfficerBoard Member Jan 1, 2022
Susan Bechtel Individual Corporate OfficerBoard Member Nov 1, 2015
Stanford Health Care Organization, Stanford, CA Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%
Thomas Jude Montine Individual Corporate OfficerBoard Member Jan 1, 2022
Randall Livingston Individual Corporate OfficerUniversity Liaison for Stanford Jan 1, 2019
Sara Abbasu Individual Corporate OfficerBoard Member May 1, 2021
Mariann Byerwalter Individual Corporate OfficerBoard Member Apr 1, 2000
David Entwistle Individual Corporate OfficerPresident & Ceo Jul 5, 2016
W-2 Managing Employee Jul 5, 2016
Kaye Foster Individual Corporate OfficerBoard Member Nov 1, 2014
Cecilia Herbert Individual Corporate OfficerBoard Member Sep 1, 2016
William Brody Individual Corporate OfficerBoard Member Nov 1, 2015
Jeffrey W Bird Individual Corporate OfficerBoard Member Jan 1, 2022
Marc Jones Individual Corporate OfficerBoard Member Jan 1, 2020
Jonathan Jay Coslet Individual Corporate OfficerBoard Member Jan 1, 2022

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Stanford Health Care Tri-ValleyPleasanton, CA, CCN 050283 Hospital 5% Or Greater Direct Ownership Interest (100%) May 18, 2015
Stanford Health CareStanford, CA, CCN 050441 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 27, 2013

Owned or controlled facilities with NPI records 8

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572393600000",
    "number": "1265581086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-723-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-723-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANFORD HEALTH CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STANFORD HEALTH CARE",
        "enumeration_date": "2007-01-10",
        "last_updated": "2019-10-30",
        "status": "A",
        "authorized_official_last_name": "AMIN-ABASSI",
        "authorized_official_first_name": "FATANA",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "510-974-8592",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "CA",
            "license": "070000662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001188115",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1288115",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HS810P",
            "state": "AS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7102213",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000A0561",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807248900",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HS811P",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CA",
            "identifier": "ZZZA4309Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092494300",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "940057626",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "034512",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "050411",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "244848",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010207789",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116853300",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "635477",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSM00441H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stanford, CA

Sources for this page

Verify at the official NPI Registry.