Active NPI
Stephen Pickering
- Periodontics
- San Mateo, CA
National Provider Identifier
1801977368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 26782
- Practice address
- 235 N San Mateo Dr Ste 100
San Mateo, CA 94401-2672 - Phone
- (650) 348-4030
- NPI assigned
- Oct 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 26782 | CA | Primary |
Addresses
Primary practice location
235 N San Mateo Dr Ste 100
San Mateo, CA 94401-2672
Mailing address
235 N San Mateo Dr Ste 100
San Mateo, CA 94401-2672
Phone (650) 348-4030
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 12, 2013 through Apr 12, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1801977368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "235 N SAN MATEO DR STE 100",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944012672",
"telephone_number": "650-348-4030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "235 N SAN MATEO DR STE 100",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944012672",
"telephone_number": "650-348-4030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PICKERING",
"first_name": "STEPHEN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-18",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "26782",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.