NPIMap

Individual provider Active NPI

Lucius K. Upshaw, PA-C

  • Physician Assistant
  • San Mateo, CA
National Provider Identifier
1932350790
Registry record updated Oct 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA19952 Issued in CA
Practice address
50 S San Mateo Dr
Suite 440
San Mateo, CA 94401-3857
Phone
(650) 558-0504
Fax
(650) 558-0323
NPI assigned
Oct 9, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 9, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA19952 CA Primary

Addresses

Primary practice location

50 S San Mateo Dr
Suite 440
San Mateo, CA 94401-3857

Mailing address

50 S San Mateo Dr
Suite 440
San Mateo, CA 94401-3857
Phone (650) 558-0504

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
I20090421000162 CA Practitioner - Physician Assistant 5092862565 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of San MateoGroup PAC ID 9032023171, shared by 15 NPIs, 316 clinicians

Practice addresses (Care Compare)

22 W 39TH Ave
San Mateo, CA 94403-4364

222 W 39TH Ave
San Mateo, CA 94403-4364

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA19952CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
County of San Mateo CurrentSince Aug 20, 2009 Accepting new patients
County of San Mateo CurrentSince Aug 20, 2009 Accepting new patients
County of San Mateo CurrentSince Sep 15, 2018 Accepting new patients
Kevin S Finnesey MD a Professional Corporation Past Accepting new patients

Locations

222 W 39th Ave
San Mateo, CA 94403
Phone (415) 573-2222

Interoperability endpoints

  • Direct secure messaging: lupshaw19994@smch.direct-ci.com

Organizations & group practices 4

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 8

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": "1223510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223510400000",
    "number": "1932350790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 S SAN MATEO DR",
            "address_2": "SUITE 440",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013857",
            "telephone_number": "650-558-0504",
            "fax_number": "650-558-0323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 S SAN MATEO DR",
            "address_2": "SUITE 440",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013857",
            "telephone_number": "650-558-0504",
            "fax_number": "650-558-0323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UPSHAW",
        "first_name": "LUCIUS",
        "middle_name": "K.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-10-09",
        "last_updated": "2008-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA19952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Mateo, CA

Sources for this page

Verify at the official NPI Registry.