NPIMap

Organization Active NPI

Pacific Medical, Inc.

Doing business as Pacific Medical Prosthetics & Orthotics

  • Prosthetic/Orthotic Supplier
  • San Jose, CA
National Provider Identifier
1467727727
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
PACIFIC MEDICAL, INC.
Doing business as
Pacific Medical Prosthetics & Orthotics
Practice address
123 Di Salvo Ave Ste 60
San Jose, CA 95128-1714
Phone
(408) 217-9387
Fax
(408) 564-0138
NPI assigned
Mar 19, 2012
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
Mark Weaver, JD
Title
General Counsel
Phone
(800) 726-9180

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Prosthetic/Orthotic Supplier 335E00000X NU Primary

Addresses

Primary practice location

123 Di Salvo Ave Ste 60
San Jose, CA 95128-1714

Mailing address

File 1616
1801 W Olympic Blvd
Pasadena, CA 91199-1616
Phone (800) 861-5920

Other practice location 1

123 Di Salvo Ave
Suite 70
San Jose, CA 95128-1717
Phone (408) 217-9387

Other names 1

  • Pacific Medical Prosthetics & Orthotics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171013000172 CA DME Supplier - Medical Supply Company With Orthotic-Prosthetic 7416076732 Practice locations: San Jose, CA

Other NPIs with the same Medicare PAC ID 22

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

View all 22

Laboratory certificates & supplier records

Derived by NPIMap

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

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Pacific Medical, Inc.123 Di Salvo Ave, San Jose, CA 95128-1717(408) 217-9387 Continuous Passive Motion (CPM) Devices|Canes and/or Crutches|Walkers|Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

123 Di Salvo Ave
Ste 70
San Jose, CA 95128
Phone (408) 217-9387

Practitioners & affiliated clinicians

Practitioners 1

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": "1332115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1467727727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE 1616",
            "address_2": "1801 W OLYMPIC BLVD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911991616",
            "telephone_number": "800-861-5920",
            "fax_number": "800-861-5950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 DI SALVO AVE STE 60",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951281714",
            "telephone_number": "408-217-9387",
            "fax_number": "408-564-0138"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "123 Di Salvo Ave",
            "address_2": "Suite 70",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "951281717",
            "country_code": "US",
            "telephone_number": "408-217-9387",
            "fax_number": "408-564-0138",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PACIFIC MEDICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-19",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "GENERAL COUNSEL",
        "authorized_official_telephone_number": "800-726-9180",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Medical Prosthetics & Orthotics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Jose, 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.
  • 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.