Individual provider Active NPI

Farzaneh Raoufi, FNP

  • Primary Care Nurse Practitioner
  • San Mateo, CA
National Provider Identifier
1710106737
Registry record updated Aug 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
NP13945 Issued in CA
Practice address
19 West 39TH Street
San Mateo, CA 94403-4549
Phone
(650) 578-0400
NPI assigned
Apr 25, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X NP13945 CA Primary

Addresses

Primary practice location

19 West 39TH Street
San Mateo, CA 94403-4549

Mailing address

19 W 39TH Ave
San Mateo, CA 94403-4593
Phone (650) 578-0400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170609002327 CA Practitioner - Nurse Practitioner 9739457086 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of Santa ClaraGroup PAC ID 1254244973, 1,000 clinicians

Practice addresses (Care Compare)

143 N Main St
Vly HLTH C Milpitas
Milpitas, CA 95035-4322
Phone (408) 885-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
13945CAMDChiropractor
NP13945CAMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
County of Santa Clara CurrentSince Mar 15, 2017 Accepting new patients
County of Santa Clara CurrentSince Mar 15, 2017 Accepting new patients
County of Santa Clara Current Accepting new patients
Samaritan House Past Accepting new patients

Locations

751 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-5110

Interoperability endpoints

  • Direct secure messaging: fraoufi86131@santaclaravalley.direct-ci.net

Organizations & group practices 4

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 1

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": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408579200000",
    "number": "1710106737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 W 39TH AVE",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944034593",
            "telephone_number": "650-578-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 WEST 39TH STREET",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944034549",
            "telephone_number": "650-578-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAOUFI",
        "first_name": "FARZANEH",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-25",
        "last_updated": "2014-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "NP13945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Mateo, CA

Sources for this page

Verify at the official NPI Registry.