NPIMap

Organization Active NPI

Mills Peninsula Medical Group

  • General Practice Physician
  • San Mateo, CA
National Provider Identifier
1588879134
Registry record updated Jan 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MILLS PENINSULA MEDICAL GROUP
Practice address
50 S San Mateo Dr
Suite 150
San Mateo, CA 94401-3857
Phone
(650) 696-9770
Fax
(650) 375-1363
NPI assigned
May 14, 2007
Last updated
Jan 31, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2008

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

Authorized official

Name
Trudy Brady, LVN
Title
Clinic Director
Phone
(650) 240-8011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

50 S San Mateo Dr
Suite 150
San Mateo, CA 94401-3857

Mailing address

50 S San Mateo Dr
Suite 150
San Mateo, CA 94401-3857
Phone (650) 696-9770

Other names 1

  • Mills-Peninsula Medical Group Clinics Other name

National Provider Directory

National Provider Directory

Locations

50 S San Mateo Dr
Ste 150
San Mateo, CA 94401
Phone (650) 696-4428

Practitioners & affiliated clinicians

Practitioners 7

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": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201737600000",
    "number": "1588879134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 S SAN MATEO DR",
            "address_2": "SUITE 150",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013857",
            "telephone_number": "650-696-9770",
            "fax_number": "650-375-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 S SAN MATEO DR",
            "address_2": "SUITE 150",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013857",
            "telephone_number": "650-696-9770",
            "fax_number": "650-375-1363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLS PENINSULA MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2008-01-31",
        "status": "A",
        "authorized_official_last_name": "BRADY",
        "authorized_official_first_name": "TRUDY",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "650-240-8011",
        "authorized_official_credential": "LVN"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mills-Peninsula Medical Group Clinics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Mateo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.