NPIMap

Individual provider Active NPI

Michael Paul Jaffe, M.D.

  • Psychiatry Physician
  • Half Moon Bay, CA
National Provider Identifier
1417081274
Registry record updated Dec 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A88623 Issued in CA
Practice address
625 Miramontes St Ste 202
Half Moon Bay, CA 94019-1942
Phone
(650) 889-3004
NPI assigned
Mar 15, 2007
Last updated
Dec 7, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X A88623 CA Primary

Addresses

Primary practice location

625 Miramontes St Ste 202
Half Moon Bay, CA 94019-1942

Mailing address

625 Miramontes St Ste 202
Half Moon Bay, CA 94019-1942

Other practice location 1

1400 Emeline Ave
Santa Cruz, CA 95060-1976
Phone (831) 454-4170

Other practice location 2

395 Oyster Point Blvd Ste 512
South San Francisco, CA 94080-1973
Phone (650) 826-2945

Other identifiers 5

IdentifierTypeStateIssuer
ZZZ91891ZOtherCACOUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#
ZZZ92069ZOtherCACOUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#
FHC 70042FOtherCACOUNTY OF SANTA CRUZ MEDI-CAL GROUP#
FHC 70044FOtherCACOUNTY OF SANTA CRUZ MEDI-CAL GROUP#
ZZZ91892ZOtherCACOUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101028000820 CA Practitioner - PsychiatryPractitioner - Neuropsychiatry 6901090497 Reassigns benefits to 2 organizations
Practice locations: Half Moon Bay, CA

Care Compare profile

Medicare Care Compare
Specialty
PsychiatryAlso: Neuropsychiatry
Education
University of California, San Diego School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of San MateoGroup PAC ID 9032023171, 316 clinicians

Practice addresses (Care Compare)

222 W 39TH Ave
San Mateo, CA 94403-4364
Phone (650) 573-2222

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
County of San Mateo CurrentSince Jun 11, 2018 Accepting new patients
County of San Mateo CurrentSince Jun 1, 2018 Accepting new patients
South County Mental Health Past Accepting new patients
Puentes Al Sur Past Accepting new patients

Locations

1950 Alameda de las Pulgas
San Mateo, CA 94403
Phone (650) 573-3571

222 W 39th Ave
San Mateo, CA 94403
Phone (415) 573-2222

Interoperability endpoints

  • Direct secure messaging: mjaffe19974@smch.direct-ci.com

Organizations & group practices 5

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

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607299200000",
    "number": "1417081274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 MIRAMONTES ST STE 202",
            "city": "HALF MOON BAY",
            "state": "CA",
            "postal_code": "940191942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 MIRAMONTES ST STE 202",
            "city": "HALF MOON BAY",
            "state": "CA",
            "postal_code": "940191942",
            "telephone_number": "650-889-3004"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 Emeline Ave",
            "address_purpose": "LOCATION",
            "city": "Santa Cruz",
            "state": "CA",
            "postal_code": "950601976",
            "country_code": "US",
            "telephone_number": "831-454-4170",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "395 Oyster Point Blvd Ste 512",
            "address_purpose": "LOCATION",
            "city": "South San Francisco",
            "state": "CA",
            "postal_code": "940801973",
            "country_code": "US",
            "telephone_number": "650-826-2945",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAFFE",
        "first_name": "MICHAEL",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-15",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A88623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#",
            "identifier": "ZZZ91891Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#",
            "identifier": "ZZZ92069Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COUNTY OF SANTA CRUZ MEDI-CAL GROUP#",
            "identifier": "FHC 70042F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COUNTY OF SANTA CRUZ MEDI-CAL GROUP#",
            "identifier": "FHC 70044F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#",
            "identifier": "ZZZ91892Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Half Moon Bay, CA

Sources for this page

Verify at the official NPI Registry.