Pacific Endoscopy LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PACIFIC ENDOSCOPY LLC

Doing business as

Atherton Endoscopy Center

Practice address

3351 El Camino Real
Ste 220
Atherton, CA 94027-3811

Phone

(650) 365-3700

NPI assigned

Nov 6, 2012

Last updated

Nov 10, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Eric Boon

Title

Officer/Ao

Phone

(480) 567-0269

Specialties & licenses 1

Addresses

Other names 1

• Atherton Endoscopy Center Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Pacific Endoscopy LLC Dba Atherton Endoscopy CenterCCN 05C0001632

Medicare certification status

ActiveFrom the Provider of Services file

Locations

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

{
    "created_epoch": "1352160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731196800000",
    "number": "1316291867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3351 EL CAMINO REAL",
            "city": "ATHERTON",
            "state": "CA",
            "postal_code": "940273811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3351 EL CAMINO REAL",
            "address_2": "STE 220",
            "city": "ATHERTON",
            "state": "CA",
            "postal_code": "940273811",
            "telephone_number": "650-365-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC ENDOSCOPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-06",
        "last_updated": "2024-11-10",
        "certification_date": "2024-11-10",
        "status": "A",
        "authorized_official_last_name": "BOON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OFFICER/AO",
        "authorized_official_telephone_number": "480-567-0269"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Atherton Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Seyed Babak Mostaan, DDS
• Nazila Doroodian DMD Inc
• Andrew B Newman, M.D.
• Katherine Wattiker Olivetti, LCSW
• Michelle Claudette Olsen, D.D.S.
• Pacific Endoscopy Services (Atherton Endoscopy Center)
• Lisa Riedle, PT
• Maria Esther Rivera, MD
• Cyrus S. Safai, M.D,
• Mahnoosh Sharifi, M.D.

• Ambulatory Surgical Clinic/Center in Atherton, CA
• Providers in Atherton, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.