NPIMap

Individual provider Active NPI

Sourav Ray, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Burlingame, CA
National Provider Identifier
1669698163
Registry record updated Oct 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
C52780 Issued in CA
Practice address
1783 El Camino Real
Mills Peninsula Pathology Dept
Burlingame, CA 94010-3205
Phone
(650) 696-5611
NPI assigned
Apr 17, 2007
Last updated
Oct 19, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X C52780 CA Primary

Addresses

Primary practice location

1783 El Camino Real
Mills Peninsula Pathology Dept
Burlingame, CA 94010-3205

Mailing address

383 E Grand Ave
Suite a
South San Francisco, CA 94080-6234
Phone (650) 616-2951

Other identifiers 1

IdentifierTypeStateIssuer
C52780OtherCACA MEDICAL LICENSE

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
I20070717000614 CA Practitioner - Pathology 0840390019 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Albany Medical College of Union University, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Peninsula Pathologists Medical Group IncGroup PAC ID 2961485925, 17 clinicians
County of San MateoGroup PAC ID 9032023171, 316 clinicians

Practice addresses (Care Compare)

1501 Trousdale Dr
Burlingame, CA 94010-4506
Phone (650) 696-5400

170 Alameda de Las Pulgas
Redwood City, CA 94062-2751
Phone (650) 367-5538

222 W 39TH Ave
San Mateo, CA 94403-4364
Phone (650) 573-2222

2500 Grant Rd
Mountain View, CA 94040-4302
Phone (650) 616-2951

383 E Grand Ave
Suite a
South San Francisco, CA 94080-6234
Phone (650) 616-2951

815 Pollard Rd
Los Gatos, CA 95032-1438
Phone (650) 616-2951

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C52780CAMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation CurrentSince May 1, 2015 Accepting new patients
Peninsula Pathologists Medical Group CurrentSince Aug 1, 2007 Accepting new patients
Peninsula Pathologists Medical Group Inc. Anatomic Pathology & Clinical Pathology CurrentSince Aug 1, 2007 Accepting new patients
County of San Mateo CurrentSince Feb 9, 2021 Accepting new patients
Sutter Bay Medical Foundation CurrentSince May 1, 2015 Accepting new patients
County of San Mateo CurrentSince Feb 9, 2021 Accepting new patients
Sutter Bay Hospitals Past Accepting new patients
Sequoia Health Services Past Accepting new patients

Locations

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

1783 El Camino Real
Burlingame, CA 94010
Phone (650) 696-5400

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

370 Distel Cir
Los Altos, CA 94022
Phone (650) 254-5200

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 324-1832

795 El Camino Real
#1112
Palo Alto, CA 94301

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

101 S San Mateo Dr
San Mateo, CA 94401
Phone 65034463535238

123 S San Mateo Dr
San Mateo, CA 94401
Phone (650) 343-4200

222 W 39th Ave
San Mateo, CA 94403
Phone (415) 573-2222

12935 Alcosta Blvd
Unit 3888
San Ramon, CA 94583

383 E Grand Ave
Ste A
South San Francisco, CA 94080
Phone (650) 616-2951

393 E Grand Ave
Ste I
South San Francisco, CA 94080
Phone (650) 589-5278

550 S Green Valley Rd
Watsonville, CA 95076
Phone (831) 458-5865

Interoperability endpoints

  • Direct secure messaging: sray21520@smch.direct-ci.com
  • Direct secure messaging: sray48109@hisp.ehr.sutterhealth.org

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 21

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192752000000",
    "number": "1669698163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "383 E GRAND AVE",
            "address_2": "SUITE A",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940806234",
            "telephone_number": "650-616-2951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1783 EL CAMINO REAL",
            "address_2": "MILLS PENINSULA PATHOLOGY DEPT",
            "city": "BURLINGAME",
            "state": "CA",
            "postal_code": "940103205",
            "telephone_number": "650-696-5611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAY",
        "first_name": "SOURAV",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-17",
        "last_updated": "2007-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "C52780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA MEDICAL LICENSE",
            "identifier": "C52780",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlingame, CA

Sources for this page

Verify at the official NPI Registry.