Arch Street Medical Associates

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

A31093 Issued in CA

Legal business name

ARCH STREET MEDICAL ASSOCIATES

Practice address

143 Birch Street
Redwood City, CA 94062

Phone

(650) 366-1141

Fax

(650) 366-1265

NPI assigned

Feb 10, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Peter J Bulluck, MD

Title

Ceo

Phone

(650) 366-1141

Specialties & licenses 1

Addresses

Other names 1

• Arch Street Medical Associates, Inc Former legal business name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Peter J Bullock, MD

  • Family Medicine Physician
  • Redwood City, CA
  • NPI 1548299027
  Medicare reassignment Care Compare group NPD
• Abraham Hafiz Rodriguez, M.D.

  • General Practice Physician
  • Pleasanton, CA
  • NPI 1851731616
  Medicare reassignment Care Compare group NPD
• Kathe Gibboney, FNP

  • Family Nurse Practitioner
  • Redwood City, CA
  • NPI 1275860470
  NPD (past)

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

{
    "created_epoch": "1297296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297382400000",
    "number": "1396041208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 BIRCH STREET",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "94062",
            "telephone_number": "650-366-1141",
            "fax_number": "650-366-1265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 BIRCH STREET",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "94062",
            "telephone_number": "650-366-1141",
            "fax_number": "650-366-1265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARCH STREET MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-10",
        "last_updated": "2011-02-11",
        "status": "A",
        "authorized_official_last_name": "BULLUCK",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "650-366-1141",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "A31093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arch Street Medical Associates, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Apurva Dabak DDS Inc
• Shallymar Aquipel
• Josephine Aranias
• Lindsay Arboleda, NP
• Faith Arca
• Madison Olivia Ard, BA
• Carla Maria Arellano
• Maria G. Arellano, NP
• Mary Rose Arellano
• Nicole Arenas

• General Practice Physician in Redwood City, CA
• Providers in Redwood City, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2011; 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.