Individual provider Active NPI

Carly Anne Stewart, PA-C

  • Medical Physician Assistant
  • Sacramento, CA
National Provider Identifier
1104050533
Registry record updated Jan 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
20286 Issued in CA
Practice address
4001 J St
Sacramento, CA 95819-3626
Phone
(916) 453-4545
NPI assigned
May 13, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 20286 CA Primary

Addresses

Primary practice location

4001 J St
Sacramento, CA 95819-3626

Mailing address

1514 Pershing Dr
Apartment B
San Francisco, CA 94129-3353
Phone (805) 878-2612

Electronic endpoints 1

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

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
I20090713000608 CA Practitioner - Physician Assistant 8325190952 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
Alameda Health SystemGroup PAC ID 3779494521, 597 clinicians

Practice addresses (Care Compare)

1411 E 31St St
Oakland, CA 94602-1018
Phone (510) 437-4800

Merit-based Incentive Payment System (MIPS)

Final score
95.17 of 100Reported as group
Quality
86.93
Promoting interoperability
100
Improvement activities
40
Cost
72.6

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20286CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California CurrentSince Aug 1, 2009 Accepting new patients
Alameda Health System CurrentSince Feb 12, 2015 Accepting new patients
Alameda Health System CurrentSince Feb 12, 2015 Accepting new patients
Alameda Health System Past Accepting new patients

Locations

2070 Clinton Ave
Alameda, CA 94501
Phone (510) 522-3700

815 Atlantic Ave
Ste 100
Alameda, CA 94501
Phone (510) 522-6637

6501 Coyle Ave
Carmichael, CA 95608
Phone (916) 537-5000

15400 Foothill Blvd
Castro Valley, CA 94578
Phone (510) 346-1468

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

1411 E 31st St
Oakland, CA 94602
Phone (510) 437-4323

1 Medical Plaza Dr
Roseville, CA 95661
Phone (916) 781-1000

4001 J St
Sacramento, CA 95819
Phone (916) 453-4037

7500 Hospital Dr
Sacramento, CA 95823
Phone (916) 423-3000

450 Stanyan St
San Francisco, CA 94117
Phone (415) 668-1000

13855 E 14th St
San Leandro, CA 94578
Phone (510) 357-6500

Interoperability endpoints

  • Direct secure messaging: cstewart13376@alamedahs.direct-ci.com

Organizations & group practices 5

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": "1242172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1104050533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 PERSHING DR",
            "address_2": "APARTMENT B",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941293353",
            "telephone_number": "805-878-2612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 J ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958193626",
            "telephone_number": "916-453-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEWART",
        "first_name": "CARLY",
        "middle_name": "ANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-13",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "20286",
            "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": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "275 W MacArthur Blvd",
            "city": "Oakland",
            "state": "CA",
            "country_code": "US",
            "postal_code": "946115641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.