NPIMap

Organization Active NPI

Ear, Nose and Throat Associates of San Mateo County Inc

  • Otolaryngology Physician
  • San Mateo, CA
National Provider Identifier
1699792598
Registry record updated Feb 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
G71603 Issued in CA
Legal business name
EAR, NOSE AND THROAT ASSOCIATES OF SAN MATEO COUNTY INC
Practice address
100 S. Ellsworth Avenue
Suite 308
San Mateo, CA 94401-3931
Phone
(650) 344-6896
Fax
(650) 344-2794
NPI assigned
Jul 16, 2006
Last updated
Feb 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2020

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

Authorized official

Name
Jennifer F. Bock Hughes, M.D.NPI 1033136916
Title
President
Phone
(650) 344-6896

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Y00000X
Otolaryngology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Y00000X G71603 CA Primary

Addresses

Primary practice location

100 S. Ellsworth Avenue
Suite 308
San Mateo, CA 94401-3931

Mailing address

100 S. Ellsworth Avenue
Suite 308
San Mateo, CA 94401-3931
Phone (650) 344-6896

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ80557ZOtherCABLUE SHIELD
ZZZ80557ZMedicaidCA

Other names 1

  • Ear, Nose & Throat Medical Group of San Mateo, Inc Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031112000326 CA Part B Supplier - Clinic/Group Practice 0547173742 Receives reassigned benefits from 8 practitioners
Practice locations: San Mateo, CA

National Provider Directory

National Provider Directory
Tax ID family
Ear Nose and Throat Associates of San Mateo County Inc2 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.

Practitioners & affiliated clinicians

Practitioners 8

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": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581379200000",
    "number": "1699792598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S. ELLSWORTH AVENUE",
            "address_2": "SUITE 308",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013931",
            "telephone_number": "650-344-6896",
            "fax_number": "650-344-2794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S. ELLSWORTH AVENUE",
            "address_2": "SUITE 308",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013931",
            "telephone_number": "650-344-6896",
            "fax_number": "650-344-2794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAR, NOSE AND THROAT ASSOCIATES OF SAN MATEO COUNTY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2020-02-11",
        "certification_date": "2020-02-11",
        "status": "A",
        "authorized_official_last_name": "BOCK HUGHES",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "650-344-6896",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "G71603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ80557Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ80557Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ear, Nose & Throat Medical Group of San Mateo, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Ear, Nose & Throat Medical Group of San Mateo, Inc",
            "code": "4",
            "type": "Former Legal Business 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 Feb 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.