NPIMap

Individual provider Active NPI

Jan Boublik, MD, PHD

  • Anesthesiology Physician
  • Stanford, CA
National Provider Identifier
1497945471
Registry record updated Apr 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
C139846 Issued in CA
Practice address
300 Pasteur Dr
Stanford, CA 94305-2200
Phone
(650) 723-4000
NPI assigned
Jul 26, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X C139846 CA Primary

Addresses

Primary practice location

300 Pasteur Dr
Stanford, CA 94305-2200

Mailing address

788 8TH Ave Apt 4
San Francisco, CA 94118-3790
Phone (917) 617-6261

Other practice location 1

300 Pasteur Dr Rm H3580
Stanford, CA 94305-2200
Phone (650) 723-6412

Other identifiers 2

IdentifierTypeStateIssuer
232132OtherMASSACHUSETTS MEDICAL BOA
256914OtherNYNY OFFICE OF THE PROFESSIONS

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
I20161012000727 CA Practitioner - Anesthesiology 3072646470 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stanford Health CareGroup PAC ID 6709797491, 3,152 clinicians

Practice addresses (Care Compare)

300 Pasteur Dr
Stanford, CA 94305-2200
Phone (650) 723-4000

420 Broadway St
Redwood City, CA 94063-3132
Phone (650) 723-4000

450 Broadway St
Redwood City, CA 94063-3132
Phone (650) 723-4000

Hospital & facility affiliations

  • Stanford Health Care Hospital, Stanford, CA, CCN 050441

Merit-based Incentive Payment System (MIPS)

Final score
88.53 of 100Reported as group
Quality
87.08
Promoting interoperability
100
Improvement activities
40
Cost
69.51

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C139846CAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
LPCH Medical Group Div of Lucile CurrentSince Sep 8, 2017 Accepting new patients
Stanford Health Care Anesthesiology CurrentSince Aug 30, 2016 Accepting new patients
Stanford Hospital and Clinics Past Accepting new patients
Lucile Salter Packard Children'S Hospital at Stanford Past Accepting new patients

Locations

725 Welch Rd
Palo Alto, CA 94304
Phone (650) 497-8979

300 Pasteur Dr
Stanford, CA 94305
Phone (650) 498-5710

300 Pasteur Dr
Rm H3580
Stanford, CA 94305
Phone (650) 723-6412

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1185408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712534400000",
    "number": "1497945471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "788 8TH AVE APT 4",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941183790",
            "telephone_number": "917-617-6261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-723-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Pasteur Dr Rm H3580",
            "address_purpose": "LOCATION",
            "city": "Stanford",
            "state": "CA",
            "postal_code": "943052200",
            "country_code": "US",
            "telephone_number": "650-723-6412",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUBLIK",
        "first_name": "JAN",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-26",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "C139846",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASSACHUSETTS MEDICAL BOA",
            "identifier": "232132",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY OFFICE OF THE PROFESSIONS",
            "identifier": "256914",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stanford, CA

Sources for this page

Verify at the official NPI Registry.