Mary Moreno, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A126876 Issued in CA

Practice address

1200 B Gale Wilson Blvd
Fairfield, CA 94533-3552

Phone

(707) 646-5000

NPI assigned

Jun 23, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Southern California Keck School of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations (25 of 28)

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Hospitalist Medicine Physicians of California, Inc

  • Internal Medicine Physician
  • Apple Valley, CA
  • NPI 1184663965

  Family Medicine

  Medicare reassignment NPD
• Inpatient Specialists of California, PC

  • Internal Medicine Physician
  • San Bernardino, CA
  • NPI 1952792475

  Family Medicine

  Medicare reassignment NPD
• Marin Hospitalist Medical Group, Inc.

  • Internal Medicine Physician
  • Greenbrae, CA
  • NPI 1023041753
  Medicare reassignment NPD
• Superior Hospitalist Medical Group Inc

  • Hospitalist Physician
  • Los Angeles, CA
  • NPI 1780047712

  Family Medicine

  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1548343510

  Family Medicine

  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD

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

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639699200000",
    "number": "1033420252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2642 HARRISON ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946123814",
            "telephone_number": "323-313-2842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 B GALE WILSON BLVD",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945333552",
            "telephone_number": "707-646-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 Alhambra Ave",
            "address_2": "Contra Costa Regional Medical Center",
            "address_purpose": "LOCATION",
            "city": "Martinez",
            "state": "CA",
            "postal_code": "945533156",
            "country_code": "US",
            "telephone_number": "925-370-5110",
            "fax_number": "925-370-5142",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORENO",
        "first_name": "MARY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-23",
        "last_updated": "2021-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NH",
            "license": "RT-2119",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A126876",
            "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": "115 Central Ave",
            "city": "Alameda",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945013244",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Devina Guadalupe Morell-Lapinski
• Patricia A Moreno Guadamuz, LMFT
• David Alejandro Moreno
• Itzel Moreno
• Justyn Cruz Moreno
• Tonanzin Moreno
• Julie Rae Morgan, BSN, RN, PHN
• Rebecca Morita-Hidalgo, RN
• Leslie Elizabeth Morones
• Amanda Jewell Morris

• Family Medicine Physician in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; 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.
• 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.