Individual provider Active NPI

George P. Gavallos, MD

  • Urology Physician
  • Hayward, CA
National Provider Identifier
1740368596
Registry record updated Dec 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
A91903 Issued in CA
Practice address
27400 Hesperian Blvd
Hayward, CA 94545-4235
Phone
(510) 784-4000
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X A91903 CA Primary

Addresses

Primary practice location

27400 Hesperian Blvd
Hayward, CA 94545-4235

Mailing address

1800 Harrison St FL 7
Oakland, CA 94612-3466
Phone (510) 625-6262

Other identifiers 1

IdentifierTypeStateIssuer
00A919030MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051228000578 CA Practitioner - Urology 3678595022 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Creighton University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

1100 Veterans Blvd
Redwood City, CA 94063-2037
Phone (650) 299-2000

1150 Veterans Blvd
Redwood City, CA 94063-2037
Phone (650) 299-2000

1190 Veterans Blvd
Redwood City, CA 94063-2037
Phone (650) 299-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A91903CAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group Inc Current Accepting new patients
Permanente Medical Group Inc CurrentSince Oct 19, 2010 Accepting new patients
Permanente Medical Group, Inc CurrentSince Oct 19, 2010 Accepting new patients
John Muir Physician Network Past Accepting new patients

Locations

27400 Hesperian Blvd
Hayward, CA 94545
Phone (510) 784-4000

1800 Harrison St
Fl 7
Oakland, CA 94612

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

1200 El Camino Real
South San Francisco, CA 94080
Phone (650) 742-2100

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

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": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640563200000",
    "number": "1740368596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 HARRISON ST FL 7",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946123466",
            "telephone_number": "510-625-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27400 HESPERIAN BLVD",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945454235",
            "telephone_number": "510-784-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAVALLOS",
        "first_name": "GEORGE",
        "middle_name": "P.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2021-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "A91903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A919030",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1200 El Camino Real",
            "city": "South San Francisco",
            "state": "CA",
            "country_code": "US",
            "postal_code": "940803208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hayward, CA

Sources for this page

Verify at the official NPI Registry.