NPIMap

Organization Active NPI

University of California SFGH Medical Group

Doing business as UCSF SFGH Maxillofacial Surgery

  • Oral & Maxillofacial Surgery (D.M.D.)
  • San Francisco, CA
National Provider Identifier
1760790398
Registry record updated Dec 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
Legal business name
UNIVERSITY OF CALIFORNIA SFGH MEDICAL GROUP
Doing business as
UCSF SFGH Maxillofacial Surgery
Practice address
1001 Potrero Ave
RM. 1N1
San Francisco, CA 94110-3518
Phone
(415) 206-8104
NPI assigned
Sep 16, 2010
Last updated
Dec 26, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2025

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

Authorized official

Name
Juanita Villanueva
Title
Director
Phone
(415) 514-2574

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X NU Primary

Addresses

Primary practice location

1001 Potrero Ave
RM. 1N1
San Francisco, CA 94110-3518

Mailing address

PO Box 743749
Los Angeles, CA 90074-3749
Phone (415) 514-3000

Other names 1

  • UCSF SFGH Maxillofacial Surgery Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031113000632 CA Part B Supplier - Clinic/Group Practice 5496668410 Receives reassigned benefits from 624 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Francisco, CA

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
SFGH Medical Group43 organizations share this tax ID, including this one

Other organizations with this tax ID 42

Organizations that report the same tax identification number in the National Provider Directory.

View all 42

Locations

1001 Potrero Ave
Rm 1N1
San Francisco, CA 94110
Phone (415) 206-6128

1001 Potrero Ave
Rm 3A32
San Francisco, CA 94110
Phone (628) 206-8291

Practitioners & affiliated clinicians

Practitioners 38

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.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766707200000",
    "number": "1760790398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743749",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900743749",
            "telephone_number": "415-514-3000",
            "fax_number": "415-502-8175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 POTRERO AVE",
            "address_2": "RM. 1N1",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941103518",
            "telephone_number": "415-206-8104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF CALIFORNIA SFGH MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-16",
        "last_updated": "2025-12-26",
        "certification_date": "2025-12-26",
        "status": "A",
        "authorized_official_last_name": "VILLANUEVA",
        "authorized_official_first_name": "JUANITA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "415-514-2574"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "UCSF SFGH Maxillofacial Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Francisco, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2025; 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.