NPIMap

Individual provider Active NPI

Tiffany Waters, P.A.

  • Surgical Physician Assistant
  • Walnut Creek, CA
National Provider Identifier
1184652695
Registry record updated Nov 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA17246 Issued in CA
Practice address
2405 Shadelands Dr
Walnut Creek, CA 94598-2444
Phone
(925) 939-8585
Fax
(925) 933-2709
NPI assigned
Jun 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA17246 CA Primary
Medical Physician Assistant 363AM0700X PA17246 CA

Addresses

Primary practice location

2405 Shadelands Dr
Walnut Creek, CA 94598-2444

Mailing address

PO Box 31396
Walnut Creek, CA 94598-8396
Phone (925) 939-8585

Other names 1

  • Tiffany Benning Former name

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
I20040413001793 CA Practitioner - Physician Assistant 1456345222 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sonora Community HospitalGroup PAC ID 4284538505, shared by 10 NPIs, 134 clinicians

Practice addresses (Care Compare)

1000 Greenley Rd
Sonora, CA 95370-5200
Phone (209) 536-5000

12811 Covey Cir
Sonora, CA 95370-5935
Phone (209) 536-5196

193 Fairview LN
Sonora, CA 95370-4828
Phone (209) 536-5100

680 Guzzi LN
Sonora, CA 95370-5288

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.78 of 100Reported as group
Quality
81.74
Promoting interoperability
97
Improvement activities
40
Cost
67.27

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA17246CAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Golden State Orthopedics & Spine CurrentSince Aug 1, 2004 Accepting new patients
Sonora Community Hospital CurrentSince Aug 31, 2020 Accepting new patients
Golden State Orthopedics & Spine CurrentSince Aug 1, 2004 Accepting new patients
Sonora Community Hospital CurrentSince Aug 31, 2020 Accepting new patients
Golden State Orthopedics & Spine Past Accepting new patients
Sutter Delta Medical Center Past Accepting new patients

Locations

350 John Muir Pkwy
Ste 155
Brentwood, CA 94513

5201 Norris Canyon Rd
Ste 230
San Ramon, CA 94583
Phone (925) 244-9355

680 Guzzi Ln
Ste 201
Sonora, CA 95370
Phone (209) 536-1785

193 Fairview Ln
Ste B
Sonora, CA 95370
Phone (209) 532-5100

193 Fairview Ln
Sonora, CA 95370
Phone (209) 536-5100

12811 Covey Cir
Sonora, CA 95370
Phone (209) 536-1785

193 Fairview Ln
Ste C
Sonora, CA 95370
Phone (209) 532-3124

680 Guzzi Ln
Ste 102
Sonora, CA 95370
Phone (209) 536-5780

680 Guzzi Ln
Ste 105
Sonora, CA 95370
Phone (209) 532-0126

1000 Greenley Rd
Sonora, CA 95370
Phone (209) 263-0803

2405 Shadelands Dr
Walnut Creek, CA 94598
Phone (615) 930-0820

Organizations & group practices 9

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 12

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": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383782400000",
    "number": "1184652695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31396",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945988396",
            "telephone_number": "925-939-8585",
            "fax_number": "925-933-2709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2405 SHADELANDS DR",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945982444",
            "telephone_number": "925-939-8585",
            "fax_number": "925-933-2709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "TIFFANY",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2013-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA17246",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA17246",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "BENNING",
            "credential": "P.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.