NPIMap

Organization Active NPI

Peninsula Pathologists Medical Group Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Burlingame, CA
National Provider Identifier
1285699793
Registry record updated Oct 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
PENINSULA PATHOLOGISTS MEDICAL GROUP INC.
Practice address
1783 El Camino Real
Pathology Dept
Burlingame, CA 94010-3205
Phone
(650) 696-5611
NPI assigned
Apr 18, 2006
Last updated
Oct 16, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2007

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

Authorized official

Name
Dr. Judy A Alonzo, M.D.NPI 1124040787
Title
President
Phone
(650) 616-2950

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Medicine Physician 207U00000X CLF331997 CA
Cytopathology Physician 207ZC0500X CLF331997 CA
Dermatopathology (Pathology) Physician 207ZD0900X CLF331997 CA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X Primary

Addresses

Primary practice location

1783 El Camino Real
Pathology Dept
Burlingame, CA 94010-3205

Mailing address

383 E Grand Ave
Suite a
South San Francisco, CA 94080-6234
Phone (650) 616-2951

Other identifiers 5

IdentifierTypeStateIssuer
GR0030570MedicaidCA
GR0030575MedicaidCA
GR0030572MedicaidCA
LAB27269FMedicaidCA
GR0030573MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040610000795 CA Part B Supplier - Clinic/Group Practice 2961485925 Receives reassigned benefits from 17 practitioners
Practice locations: Burlingame, CA; South San Francisco, CA; San Mateo, CA; San Francisco, CA; Mountain View, CA; Redwood City, CA; Los Gatos, CA

National Provider Directory

National Provider Directory

Locations

3555 Cesar Chavez
San Francisco, CA 94110
Phone (415) 485-8824

383 E Grand Ave
Ste A
South San Francisco, CA 94080
Phone (650) 616-2951

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192492800000",
    "number": "1285699793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "383 E GRAND AVE",
            "address_2": "SUITE A",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940806234",
            "telephone_number": "650-616-2951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1783 EL CAMINO REAL",
            "address_2": "PATHOLOGY DEPT",
            "city": "BURLINGAME",
            "state": "CA",
            "postal_code": "940103205",
            "telephone_number": "650-696-5611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA PATHOLOGISTS MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-18",
        "last_updated": "2007-10-16",
        "status": "A",
        "authorized_official_last_name": "ALONZO",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "650-616-2950",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": "CA",
            "license": "CLF331997",
            "primary": false
        },
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "CA",
            "license": "CLF331997",
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "CA",
            "license": "CLF331997",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0030570",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0030575",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0030572",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB27269F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0030573",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlingame, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.