Peninsula OBGYN Integrative

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

PENINSULA OBGYN INTEGRATIVE

Practice address

101 S San Mateo Dr Ste 111
San Mateo, CA 94401-3840

Phone

(650) 542-0092

Fax

(650) 389-6960

NPI assigned

Oct 1, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Samuel Young, MDNPI 1588737894

Title

President

Phone

(650) 281-8716

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

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

• Samuel Young, M.D.

  • Obstetrics & Gynecology Physician
  • San Francisco, CA
  • NPI 1588737894
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1538352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566172800000",
    "number": "1669957114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 DE ANZA BLVD # 72",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944023989",
            "telephone_number": "650-281-8716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S SAN MATEO DR STE 111",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013840",
            "telephone_number": "650-542-0092",
            "fax_number": "650-389-6960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA OBGYN INTEGRATIVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-01",
        "last_updated": "2019-08-19",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "650-281-8716",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peninsula Gastrointestinal
• Peninsula Health Care District
• Peninsula Medical Associates
• Peninsula Nephrology, Inc.
• Peninsula Nephrology, Inc.
• Peninsula Pediatric Dental Practice
• Peninsula Pediatric Med GRP Inc
• Peninsula Spine & Sports Rehab, a Rommel Hindocha Chiropractic Corp.
• Peninsula Spine Education &Treatment Center
• Peninsula Ultrasound, Mammography & Radiology Services Medical Group

• Obstetrics & Gynecology Physician in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2019; 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.