Individual provider Active NPI

Stacy M Lagomarsino, PAC

  • Surgical Physician Assistant
  • San Francisco, CA
National Provider Identifier
1033240833
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA18133 Issued in CA
Practice address
1600 Owens St
San Francisco, CA 94158-2261
Phone
(415) 833-2000
NPI assigned
Mar 7, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA18133 CA Primary

Addresses

Primary practice location

1600 Owens St
San Francisco, CA 94158-2261

Mailing address

4601 Dale Rd
Modesto, CA 95356-9718
Phone (209) 735-6102

Other names 1

  • Stacy Garrison Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080119000108 CA Practitioner - Physician Assistant 0840371548 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA18133CAMDSurgical Physician Assistant
18133CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group Inc CurrentSince Aug 1, 2024 Accepting new patients
Permanente Medical Group, Inc CurrentSince Aug 1, 2024 Accepting new patients

Locations

4601 Dale Rd
Modesto, CA 95356
Phone (209) 557-1000

101 Monroe St
Petaluma, CA 94954
Phone (707) 763-4109

5820 Owens Dr
Bldg E
Pleasanton, CA 94588
Phone (925) 737-3785

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

501 J St
Sacramento, CA 95814
Phone (916) 497-3000

1600 Owens St
San Francisco, CA 94158
Phone (415) 833-2200

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

5615 Scotts Valley Dr
Scotts Valley, CA 95066
Phone (831) 430-2700

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728604800000",
    "number": "1033240833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 DALE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569718",
            "telephone_number": "209-735-6102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 OWENS ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941582261",
            "telephone_number": "415-833-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAGOMARSINO",
        "first_name": "STACY",
        "middle_name": "M",
        "credential": "PAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-07",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA18133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1600 Owens St",
            "city": "San Francisco",
            "state": "CA",
            "country_code": "US",
            "postal_code": "94158",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "GARRISON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.