NPIMap

Organization Active NPI

Lucile Salter Packard Children's Hospital at Stanford

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Palo Alto, CA
National Provider Identifier
1447313770
Registry record updated Mar 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD
Practice address
725 Welch Rd
Mail Code 5500
Palo Alto, CA 94304-1601
Phone
(650) 497-8357
Fax
(650) 493-2491
NPI assigned
Dec 18, 2006
Last updated
Mar 19, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 19, 2008

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

Authorized official

Name
Tim Carmack
Title
Chief Financial Officer
Phone
(650) 736-0031

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NU Primary

Addresses

Primary practice location

725 Welch Rd
Mail Code 5500
Palo Alto, CA 94304-1601

Mailing address

725 Welch Rd
Mail Code 5500
Palo Alto, CA 94304-1601
Phone (650) 497-8357

Other identifiers 1

IdentifierTypeStateIssuer
CDC052390FMedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040924000985 CA Part A Provider - End-Stage Renal Disease Facility (ESRD) 9436121720 Practice locations: Palo Alto, CA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Lucile Packard Stanford Pediatric DialysisCCN 052390
Overall star rating
1.0 of 5
Ownership
Non-profit
Certified
Apr 13, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
6

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Tax ID family
Lucile Salter Packard Children's Hospital at Stanford12 organizations share this tax ID, including this one
Part of
Lucile Salter Packard Children's Hospital at Stanford

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205884800000",
    "number": "1447313770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 WELCH RD",
            "address_2": "MAIL CODE 5500",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041601",
            "telephone_number": "650-497-8357",
            "fax_number": "650-493-2491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 WELCH RD",
            "address_2": "MAIL CODE 5500",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041601",
            "telephone_number": "650-497-8357",
            "fax_number": "650-493-2491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LUCILE SALTER PACKARD CHILDREN'S HOSPITAL AT STANFORD",
        "enumeration_date": "2006-12-18",
        "last_updated": "2008-03-19",
        "status": "A",
        "authorized_official_last_name": "CARMACK",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "650-736-0031"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CDC052390F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palo Alto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2008; 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.