NPIMap

Individual provider Active NPI

Karl Craig Bruckman, MD, DDS

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Palo Alto, CA
National Provider Identifier
1841452612
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
A163334 Issued in CA
Practice address
300 Pasteur Dr
Palo Alto, CA 94304-2203
Phone
(650) 723-4000
NPI assigned
Jul 1, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X A163334 CA Primary
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X 61299 CT
Plastic Surgery Physician 208200000X 61299 CT
Plastic Surgery Physician 208200000X A163334 CA

Addresses

Primary practice location

300 Pasteur Dr
Palo Alto, CA 94304-2203

Mailing address

300 Pasteur Dr
Palo Alto, CA 94304-2203
Phone (650) 723-4000

Other practice location 1

800 Howard Avenue
4th Floor
New Haven, CT 06519
Phone (203) 785-2570

Other practice location 2

730 Welch Rd
Palo Alto, CA 94304
Phone (650) 723-4883

Other practice location 3

730 Welch Rd
Palo Alto, CA 94304
Phone (650) 723-4883

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190830000863 CA Practitioner - Oral SurgeryPractitioner - Plastic and Reconstructive Surgery 4688921000 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Oral SurgeryAlso: Plastic and Reconstructive Surgery
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stanford Health CareGroup PAC ID 6709797491, 3,152 clinicians

Practice addresses (Care Compare)

300 Pasteur Dr
Stanford, CA 94305-2200
Phone (650) 723-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.53 of 100Reported as group
Quality
87.08
Promoting interoperability
100
Improvement activities
40
Cost
69.51

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A163334CAMDPlastic Surgery Physician
61299CTMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stanford Health Care CurrentSince Aug 5, 2019 Accepting new patients
LPCH Medical Group Div of Lucile CurrentSince Aug 5, 2019 Accepting new patients
Stanford Health Care CurrentSince Aug 5, 2019 Accepting new patients
Stanford Hospital and Clinics Past Accepting new patients
Lucile Salter Packard Children's Hospital at Stanford Past Accepting new patients
Yale New Haven Hospital Past Accepting new patients

Locations

7999 Gateway Blvd
Ste 200
Newark, CA 94560
Phone (510) 806-2947

730 Welch Rd
Palo Alto, CA 94304
Phone (650) 723-4800

1000 Welch Rd
Palo Alto, CA 94304
Phone (650) 497-8856

300 Pasteur Dr
Palo Alto, CA 94304
Phone (650) 723-6469

725 Welch Rd
Palo Alto, CA 94304
Phone (650) 497-8979

1100 Van Ness Ave
Fl 7
San Francisco, CA 94109
Phone (415) 600-4050

300 Pasteur Dr
Stanford, CA 94305
Phone (650) 498-5710

Organizations & group practices 6

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 7

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": "1214870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714348800000",
    "number": "1841452612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943042203",
            "telephone_number": "650-723-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943042203",
            "telephone_number": "650-723-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Howard Avenue",
            "address_2": "4th Floor",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "06519",
            "country_code": "US",
            "telephone_number": "203-785-2570",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "730 Welch Rd",
            "address_purpose": "LOCATION",
            "city": "Palo Alto",
            "state": "CA",
            "postal_code": "94304",
            "country_code": "US",
            "telephone_number": "650-723-4883",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "730 Welch Rd",
            "address_purpose": "LOCATION",
            "city": "Palo Alto",
            "state": "CA",
            "postal_code": "94304",
            "country_code": "US",
            "telephone_number": "650-723-4883",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUCKMAN",
        "first_name": "KARL",
        "middle_name": "CRAIG",
        "credential": "MD, DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-01",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "CA",
            "license": "A163334",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "CT",
            "license": "61299",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "CT",
            "license": "61299",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "A163334",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palo Alto, CA

Sources for this page

Verify at the official NPI Registry.