Pediatric Medical Group of San Francisco Inc

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

C3896319 Issued in CA

Legal business name

PEDIATRIC MEDICAL GROUP OF SAN FRANCISCO INC

Practice address

901 Campus Dr
Suite 207
Daly City, CA 94015-4900

Phone

(415) 242-5433

Fax

(415) 242-8904

NPI assigned

Aug 16, 2006

Last updated

Nov 30, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mary Ann Santos Fernandez, M.D.NPI 1740277995

Title

President

Phone

(415) 242-5433

Specialties & licenses 1

Addresses

Other names 1

• The Pediatric Medical Group of San Francisco Former legal business name

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

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 3

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.

• Mary Ann Santos Fernandez, M.D.

  • Pediatrics Physician
  • Daly City, CA
  • NPI 1740277995
  NPD (past) Authorized official
• Martin Andrew Fung, M.D.

  • Pediatrics Physician
  • San Francisco, CA
  • NPI 1255497897
  NPD (past)
• Dianne C Gee, CPNP

  • Legal Medicine
  • Daly City, CA
  • NPI 1457451569
  NPD (past)

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480464000000",
    "number": "1477666352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 CAMPUS DR",
            "address_2": "SUITE 207",
            "city": "DALY CITY",
            "state": "CA",
            "postal_code": "940154900",
            "telephone_number": "415-242-5433",
            "fax_number": "415-242-8904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 CAMPUS DR",
            "address_2": "SUITE 207",
            "city": "DALY CITY",
            "state": "CA",
            "postal_code": "940154900",
            "telephone_number": "415-242-5433",
            "fax_number": "415-242-8904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC MEDICAL GROUP OF SAN FRANCISCO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2016-11-30",
        "status": "A",
        "authorized_official_last_name": "FERNANDEZ",
        "authorized_official_first_name": "MARY ANN",
        "authorized_official_middle_name": "SANTOS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "415-242-5433",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Legal Medicine",
            "state": "CA",
            "license": "C3896319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Pediatric Medical Group of San Francisco",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Legal Medicine in Daly City, CA
• Providers in Daly City, CA by specialty
• Legal Medicine in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.