NPIMap

Organization Active NPI

Minimally Invasive Surgical Solutions Medical Corporation

  • Vascular & Interventional Radiology Physician
  • San Jose, CA
National Provider Identifier
1821167628
Registry record updated Jun 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
Legal business name
MINIMALLY INVASIVE SURGICAL SOLUTIONS MEDICAL CORPORATION
Practice address
105 N Bascom Ave Ste 104
San Jose, CA 95128-1811
Phone
(408) 918-0405
Fax
(408) 918-0409
NPI assigned
Nov 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2025

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

Authorized official

Name
Ms. Maria Andrade
Title
Credentialing Coordinator
Phone
(408) 918-0405

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X Primary

Addresses

Primary practice location

105 N Bascom Ave Ste 104
San Jose, CA 95128-1811

Mailing address

105 N Bascom Ave Ste 104
San Jose, CA 95128-1811
Phone (408) 918-0405

Other identifiers 1

IdentifierTypeStateIssuer
GR0095460MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040315001141 CA Part B Supplier - Clinic/Group Practice 2163311101 Receives reassigned benefits from 11 practitioners
Practice locations: San Jose, CA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1083684Minimally Invasive Surgical Solutions105 N Bascom Ste 104, San Jose, CA 95128Certificate of waiverMay 7, 2028

National Provider Directory

National Provider Directory

Locations

2030 Forest Ave
Ste 200
San Jose, CA 95128
Phone (408) 918-0405

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749513600000",
    "number": "1821167628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 N BASCOM AVE STE 104",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951281811",
            "telephone_number": "408-918-0405",
            "fax_number": "408-918-0409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 N BASCOM AVE STE 104",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951281811",
            "telephone_number": "408-918-0405",
            "fax_number": "408-918-0409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINIMALLY INVASIVE SURGICAL SOLUTIONS MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A",
        "authorized_official_last_name": "ANDRADE",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "408-918-0405",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0095460",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2025; 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.