NPIMap

Organization Active NPI

Stanford Hospital and Clinics

  • Psychologist
  • Stanford, CA
National Provider Identifier
1295863405
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
STANFORD HOSPITAL AND CLINICS
Practice address
300 Pasteur Drive
RM A343
Stanford, CA 94305-5235
Phone
(650) 498-7875
Fax
(650) 498-7868
NPI assigned
Mar 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Mark Burdelle
Title
Neurodiagnostic Lab Manager
Phone
(650) 723-0244

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103G00000X
PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

300 Pasteur Drive
RM A343
Stanford, CA 94305-5235

Mailing address

300 Pasteur Drive
RM A343
Stanford, CA 94305-5235
Phone (650) 498-7875

Other identifiers 1

IdentifierTypeStateIssuer
PSY124930MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
UCSF Stanfordhealth Car49 organizations share this tax ID, including this one

Other organizations with this tax ID 48

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

View all 48

Locations

300 Pasteur Dr
Rm A343
Stanford, CA 94305
Phone (650) 723-6469

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1295863405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DRIVE",
            "address_2": "RM A343",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943055235",
            "telephone_number": "650-498-7875",
            "fax_number": "650-498-7868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DRIVE",
            "address_2": "RM A343",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943055235",
            "telephone_number": "650-498-7875",
            "fax_number": "650-498-7868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANFORD HOSPITAL AND CLINICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "BURDELLE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "NEURODIAGNOSTIC LAB MANAGER",
        "authorized_official_telephone_number": "650-723-0244"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PSY124930",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stanford, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.