NPIMap

Organization Active NPI

Mid Peninsula Eye Physicians & Surgeons Medical Group

Doing business as Pacific Eye Specialists

  • Ophthalmology Physician
  • San Mateo, CA
National Provider Identifier
1407924889
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
TAX ID# Issued in CA
Legal business name
MID PENINSULA EYE PHYSICIANS & SURGEONS MEDICAL GROUP
Doing business as
Pacific Eye Specialists
Practice address
50 S San Mateo Dr
Suite 200
San Mateo, CA 94401-3857
Phone
(650) 342-4595
Fax
(650) 342-3932
NPI assigned
Dec 1, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Natalie Kasumov
Title
Director of Operations
Phone
(650) 342-4595

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X TAX ID# CA Primary

Addresses

Primary practice location

50 S San Mateo Dr
Suite 200
San Mateo, CA 94401-3857

Mailing address

50 S San Mateo Dr
Suite 200
San Mateo, CA 94401-3857
Phone (650) 342-4595

Other names 1

  • PACIFIC EYE SPECIALISTS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090625000691 CA Part B Supplier - Clinic/Group Practice 2163573437 Receives reassigned benefits from 11 practitioners
Practice locations: San Mateo, CA

National Provider Directory

National Provider Directory
Tax ID family
Mid Peninsula Eye Phys Sur Med2 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.

Locations

50 S San Mateo Dr
Ste 200
San Mateo, CA 94401
Phone (650) 342-4595

Practitioners & affiliated clinicians

Practitioners 11

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": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1407924889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 S SAN MATEO DR",
            "address_2": "SUITE 200",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013857",
            "telephone_number": "650-342-4595",
            "fax_number": "650-342-3932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 S SAN MATEO DR",
            "address_2": "SUITE 200",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013857",
            "telephone_number": "650-342-4595",
            "fax_number": "650-342-3932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID PENINSULA EYE PHYSICIANS & SURGEONS MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KASUMOV",
        "authorized_official_first_name": "NATALIE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "650-342-4595"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "TAX ID#",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PACIFIC EYE SPECIALISTS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Mateo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.