NPIMap

Organization Active NPI

Mission Peak Orthopaedic Medical Group Inc.

  • Orthopaedic Surgery Physician
  • Hayward, CA
National Provider Identifier
1326394974
Registry record updated Dec 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
MISSION PEAK ORTHOPAEDIC MEDICAL GROUP INC.
Practice address
27206 Calaroga Ave
Suite 107
Hayward, CA 94545-4300
Phone
(510) 300-9898
Fax
(510) 797-5184
NPI assigned
Aug 1, 2012
Last updated
Dec 23, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2013

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

Authorized official

Name
Lingagoud Memula
Title
Administrator
Phone
(510) 818-2011

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X NU Primary
Physical Medicine & Rehabilitation Physician 208100000X NU
Foot & Ankle Surgery Podiatrist 213ES0103X NU

Addresses

Primary practice location

27206 Calaroga Ave
Suite 107
Hayward, CA 94545-4300

Mailing address

39350 Civic Center Dr Ste 300
Fremont, CA 94538-2331
Phone (510) 797-3933

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ5427ZOtherCABLUE SHIELD

National Provider Directory

National Provider Directory
Tax ID family
Mission Peak Orthopaedi2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1343779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387756800000",
    "number": "1326394974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39350 CIVIC CENTER DR STE 300",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945382331",
            "telephone_number": "510-797-3933",
            "fax_number": "510-797-5184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27206 CALAROGA AVE",
            "address_2": "SUITE 107",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945454300",
            "telephone_number": "510-300-9898",
            "fax_number": "510-797-5184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION PEAK ORTHOPAEDIC MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-01",
        "last_updated": "2013-12-23",
        "status": "A",
        "authorized_official_last_name": "MEMULA",
        "authorized_official_first_name": "LINGAGOUD",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "510-818-2011"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ5427Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hayward, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2013; 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.