NPIMap

Individual provider Active NPI

Nicholas Alexander Telischak, M.D.

  • Neuroradiology Physician
  • Stanford, CA
National Provider Identifier
1629244850
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuroradiology PhysicianTaxonomy code 2085N0700X
License
A109575 Issued in CA
Practice address
300 Pasteur Dr
Stanford, CA 94305-2200
Phone
(650) 723-4000
NPI assigned
May 7, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology Physician 2085N0700X A109575 CA Primary
Diagnostic Radiology Physician 2085R0202X A109575 CA

Addresses

Primary practice location

300 Pasteur Dr
Stanford, CA 94305-2200

Mailing address

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

Other practice location 1

504 Redwood Blvd
Ste 300
Novato, CA 94947-6925
Phone (415) 884-3415

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
I20160906000861 CA Practitioner - Diagnostic Radiology 2163718925 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Geisel School of Medicine at Dartmouth, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
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

Hospital & facility affiliations

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

State licenses

LicenseStateTypeSpecialty
A109575CAMDNeuroradiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stanford Health Care Diagnostic Radiology CurrentSince Apr 1, 2019 Accepting new patients
Stanford Health Care Diagnostic Radiology Current Accepting new patients
Stanford Health Care CurrentSince Apr 1, 2019 Accepting new patients
LPCH Medical Group Div of Lucile CurrentSince Apr 1, 2019 Accepting new patients
Prima Medical Foundation CurrentSince Aug 29, 2018 Accepting new patients
Prima Medical Group, Inc. Past Accepting new patients

Locations

1720 El Camino Real
Ste 118
Burlingame, CA 94010
Phone (650) 636-7850

1501 Trousdale Dr
Burlingame, CA 94010
Phone (650) 696-3520

1240 S Eliseo Dr
Ste 103
Greenbrae, CA 94904
Phone (415) 461-7770

1260 S Eliseo Dr
Fl 2
Greenbrae, CA 94904
Phone (415) 464-1350

1260 S Eliseo Dr
Ste 101
Greenbrae, CA 94904
Phone (415) 461-9033

250 Bon Air Rd
Kentfield, CA 94904
Phone (415) 464-1350

7999 Gateway Blvd
Ste 200
Newark, CA 94560
Phone (510) 806-2947

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

170 Alameda de las Pulgas
Redwood City, CA 94062
Phone (650) 367-5536

2333 Buchanan St
San Francisco, CA 94115
Phone (415) 563-4321

347 Andrieux St
Sonoma, CA 95476
Phone (707) 935-5000

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

Interoperability endpoints

  • Direct secure messaging: ntelischak349142@hisp.ehr.sutterhealth.org
  • Direct secure messaging: ntelischak48594@direct.stanfordhealthcare.org

Organizations & group practices 6

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 8

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": "1210118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712275200000",
    "number": "1629244850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-723-4000"
        },
        {
            "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": "504 REDWOOD BLVD",
            "address_2": "STE 300",
            "address_purpose": "LOCATION",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949476925",
            "country_code": "US",
            "telephone_number": "415-884-3415",
            "fax_number": "415-883-0877",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TELISCHAK",
        "first_name": "NICHOLAS",
        "middle_name": "ALEXANDER",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-07",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "CA",
            "license": "A109575",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A109575",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stanford, CA

Sources for this page

Verify at the official NPI Registry.