NPIMap

Organization Active NPI

James Petros, M.D., Inc.

  • Physical Medicine & Rehabilitation Physician
  • San Leandro, CA
National Provider Identifier
1710620554
Registry record updated Apr 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
JAMES PETROS, M.D., INC.
Practice address
433 Estudillo Ave Ste 305
San Leandro, CA 94577-4915
Phone
(408) 528-8833
Fax
(408) 827-4171
NPI assigned
Apr 19, 2022
Organization subpart
Yes
Parent organization
JAMES PETROS, MD, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 19, 2022

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

Authorized official

Name
Michelle Waterstreet
Title
Manager
Phone
(408) 528-8833

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
AcupuncturistGroup: 193200000X MULTI-SPECIALTY GROUP 171100000X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X
Physical Therapy AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 225200000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

433 Estudillo Ave Ste 305
San Leandro, CA 94577-4915

Mailing address

1604 Blossom Hill Rd Ste 10
San Jose, CA 95124-6350
Phone (408) 528-8833

Other names 1

  • Allied Pain & Spine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110803000651 CA Part B Supplier - Clinic/Group Practice 0941479216 Receives reassigned benefits from 32 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Los Gatos, CA; Morgan Hill, CA; Mountain View, CA; San Jose, CA; San Leandro, CA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
James Petros MD Inc

Locations

433 Estudillo Ave
Ste 305
San Leandro, CA 94577
Phone (408) 528-8833

Practitioners & affiliated clinicians

Practitioners 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1650326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650326400000",
    "number": "1710620554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1604 BLOSSOM HILL RD STE 10",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951246350",
            "telephone_number": "408-528-8833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 ESTUDILLO AVE STE 305",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945774915",
            "telephone_number": "408-528-8833",
            "fax_number": "408-827-4171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMES PETROS, M.D., INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JAMES PETROS, MD, INC.",
        "enumeration_date": "2022-04-19",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A",
        "authorized_official_last_name": "WATERSTREET",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "408-528-8833"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Allied Pain & Spine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Leandro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; 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.