Peninsula Biomedical, Inc.

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

1196930001 Issued in CA

Legal business name

PENINSULA BIOMEDICAL, INC.

Practice address

15 Camp Evers LN
Scotts Valley, CA 95066-4128

Phone

(831) 430-9066

Fax

(831) 430-9068

NPI assigned

Oct 27, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Amanda Criswell

Title

Insurance Billing Manager

Phone

(831) 430-9066

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• Peninsula Medical, Inc. Doing business as

Locations

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376629998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 CAMP EVERS LN",
            "city": "SCOTTS VALLEY",
            "state": "CA",
            "postal_code": "950664128",
            "telephone_number": "831-430-9066",
            "fax_number": "831-430-9068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 CAMP EVERS LN",
            "city": "SCOTTS VALLEY",
            "state": "CA",
            "postal_code": "950664128",
            "telephone_number": "831-430-9066",
            "fax_number": "831-430-9068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA BIOMEDICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CRISWELL",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "INSURANCE BILLING MANAGER",
        "authorized_official_telephone_number": "831-430-9066",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "CA",
            "license": "1196930001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4549517",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "82712600",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9048612",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "29401372",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2107491",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9102475",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peninsula Medical, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Heidi Paris
• Danica Parungao
• Christine Pascoe
• Alisha Patel, ATC
• Ashzra Pedersen, DNP, RN, FNP-C, AGNP
• Peninsula Biomedical, Inc.
• Melissa Perez
• Andrew Pflueger, LMFT
• Tracy Pham, RPH
• Lauren Phillips

• Customized Equipment (DME) in Scotts Valley, CA
• Providers in Scotts Valley, CA by specialty
• Customized Equipment (DME) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.