Executive Endoscopy, Inc.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

070000639 Issued in CA

Legal business name

EXECUTIVE ENDOSCOPY, INC.

Practice address

2100 Forest Ave
Suite 109
San Jose, CA 95128

Phone

(408) 297-2314

Fax

(408) 297-2414

NPI assigned

Jan 12, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Felix K. Tam, M.D.

Title

Clinic Director/Secretary of Atf Co

Phone

(408) 297-2314

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• ENDOSCOPY CENTER OF SAN JOSE Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Endoscopy Center of San JoseCCN 05C0001553

Medicare certification status

ActiveFrom the Provider of Services file

Tax ID family

Endoscopy Center of San Jose2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Executive Endoscopy, Inc

  • Ambulatory Surgical Clinic/Center
  • San Jose, CA
  • NPI 1194712109
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David W Chui, MD

  • Gastroenterology Physician
  • San Jose, CA
  • NPI 1942373998
  NPD (past)

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218758400000",
    "number": "1598815110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 FOREST AVE",
            "address_2": "SUITE 109",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95128",
            "telephone_number": "408-297-2314",
            "fax_number": "408-297-2414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 FOREST AVE",
            "address_2": "SUITE 109",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95128",
            "telephone_number": "408-297-2314",
            "fax_number": "408-297-2414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE ENDOSCOPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2008-08-15",
        "status": "A",
        "authorized_official_last_name": "TAM",
        "authorized_official_first_name": "FELIX",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "CLINIC DIRECTOR/SECRETARY OF ATF CO",
        "authorized_official_telephone_number": "408-297-2314",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "070000639",
            "primary": true
        },
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SUR01553F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ENDOSCOPY CENTER OF SAN JOSE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Ambulatory Surgical Clinic/Center in San Jose, CA
• Providers in San Jose, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 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.