Peninsula Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PENINSULA SURGERY CENTER, LLC

Practice address

350 Marine Pkwy Ste 100
Redwood City, CA 94065-5224

Phone

(510) 406-9731

NPI assigned

Aug 14, 2020

Organization subpart

No

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

Authorized official

Name

Trevin Hunt

Title

Administrator

Phone

(510) 406-9731

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Peninsula Surgery Center LLCCCN 55C0001105

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

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.

• John Terry Dearborn, MD

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Menlo Park, CA
  • NPI 1396786901
  NPD

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

{
    "created_epoch": "1597363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597363200000",
    "number": "1740891571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2299 MOWRY AVE",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381621",
            "telephone_number": "510-406-9731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 MARINE PKWY STE 100",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940655224",
            "telephone_number": "510-406-9731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-14",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A",
        "authorized_official_last_name": "HUNT",
        "authorized_official_first_name": "TREVIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "510-406-9731"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peninsula Gastroenterology Medical Group Inc
• Peninsula Orthodontic Group, Inc
• Peninsula Procedure Center, LP
• Peninsula Rsi Chiropractic Wellness Center, Inc (Peninsula RSI Chiropractic Wellness Center)
• Peninsula Rsi Chiropractic Wellness Center, Inc (PENINSULA RSI Chiropractic Wellness Center)
• Peninsula Urology Center Inc
• Taylor J Pennelli, DPT
• Ana Paula Pereira
• Cielo Anett Perez-Lopez
• Evangelina Perez

• Ambulatory Surgical Clinic/Center in Redwood City, CA
• Providers in Redwood City, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.