NPIMap

Individual provider Active NPI

Peter S Uzelac, M.D.

  • Reproductive Endocrinology Physician
  • Greenbrae, CA
National Provider Identifier
1356345789
Registry record updated Feb 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Reproductive Endocrinology PhysicianTaxonomy code 207VE0102X
License
A72448 Issued in CA
Practice address
1100 S Eliseo Dr Ste 107
Attn: Jaimie Vigil
Greenbrae, CA 94904-2017
Phone
(415) 925-9404
Fax
(415) 484-7045
NPI assigned
Jun 13, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Reproductive Endocrinology Physician 207VE0102X A72448 CA Primary

Addresses

Primary practice location

1100 S Eliseo Dr Ste 107
Attn: Jaimie Vigil
Greenbrae, CA 94904-2017

Mailing address

1100 S Eliseo Dr Ste 107
Attn: Jaimie Vigil
Greenbrae, CA 94904-2017
Phone (415) 925-9404

Other identifiers 6

IdentifierTypeStateIssuer
50011330OtherKYPASSPORT SPECIALITY PSC
50011331OtherKYPASSPORT SPECIALITY- FOUNDATION
50011332OtherKYPASSPORT PCP FOUNDATION
200878600MedicaidIN
64120736MedicaidKY
000000480316OtherKYANTHEM PSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A72448CAMDReproductive Endocrinology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Peter Uzelac MD, Inc Past Accepting new patients
The University Gynecological & Obstetrical Foundation, Inc. Past Accepting new patients
Sonoma Valley Health Care District Past Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Usc Obstetricians and Gynecologists, Inc. Past Accepting new patients
Marin General Hospital Past Accepting new patients
Usc University Hospital, Inc. Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391558400000",
    "number": "1356345789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 S ELISEO DR STE 107",
            "address_2": "ATTN: JAIMIE VIGIL",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "949042017",
            "telephone_number": "415-925-9404",
            "fax_number": "415-484-7045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 S ELISEO DR STE 107",
            "address_2": "ATTN: JAIMIE VIGIL",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "949042017",
            "telephone_number": "415-925-9404",
            "fax_number": "415-484-7045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UZELAC",
        "first_name": "PETER",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-13",
        "last_updated": "2014-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VE0102X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Reproductive Endocrinology",
            "state": "CA",
            "license": "A72448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT SPECIALITY PSC",
            "identifier": "50011330",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT SPECIALITY- FOUNDATION",
            "identifier": "50011331",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT PCP   FOUNDATION",
            "identifier": "50011332",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200878600",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64120736",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PSC",
            "identifier": "000000480316",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenbrae, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2014; 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.