NPIMap

Organization Active NPI

Redwood Pulmonary Medical Associates a Medical Corporation

  • Pulmonary Disease Physician
  • Redwood City, CA
National Provider Identifier
1720083157
Registry record updated Nov 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
G74100 Issued in CA
Legal business name
REDWOOD PULMONARY MEDICAL ASSOCIATES A MEDICAL CORPORATION
Practice address
170 Alameda de Las Pulgas
Redwood City, CA 94062-2751
Phone
(650) 367-5636
Fax
(650) 367-5110
NPI assigned
Jun 13, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2017

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

Authorized official

Name
Melissa Susann Lim, M.D.NPI 1013910777
Title
President
Phone
(650) 367-5636

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
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X G74100 CA Primary
Sleep Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RS0012X G74100 CA

Addresses

Primary practice location

170 Alameda de Las Pulgas
Redwood City, CA 94062-2751

Mailing address

170 Alameda de Las Pulgas
Redwood City, CA 94062-2751
Phone (650) 367-5636

Other identifiers 1

IdentifierTypeStateIssuer
GR0095050MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060927000254 CA Part B Supplier - Clinic/Group Practice 6204873789 Receives reassigned benefits from 8 practitioners
Practice locations: Redwood City, CA

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1331 S Eliseo Dr
Ste 3
Greenbrae, CA 94904
Phone (415) 925-1416

1615 Hill Rd
Ste 15
Novato, CA 94947
Phone (415) 898-0801

170 Alameda de las Pulgas
#G68
Redwood City, CA 94062

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510185600000",
    "number": "1720083157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 ALAMEDA DE LAS PULGAS",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940622751",
            "telephone_number": "650-367-5636",
            "fax_number": "650-367-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 ALAMEDA DE LAS PULGAS",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940622751",
            "telephone_number": "650-367-5636",
            "fax_number": "650-367-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDWOOD PULMONARY MEDICAL ASSOCIATES A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-13",
        "last_updated": "2017-11-09",
        "status": "A",
        "authorized_official_last_name": "LIM",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "SUSANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "650-367-5636",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CA",
            "license": "G74100",
            "primary": true
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "CA",
            "license": "G74100",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0095050",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Redwood City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2017; 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.