Kelly Mead Gaughen, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

20A22401 Issued in CA

Practice address

20101 Lake Chabot Rd FL 3
Castro Valley, CA 94546-5305

Phone

(510) 886-3400

NPI assigned

Jun 25, 2012

Last updated

Oct 3, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kgaughen683178@hisp.ehr.sutterhealth.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sutter Bay Medical Foundation

  dba Palo Alto Medial Foundation

  • Multi-Specialty Clinic/Center
  • Palo Alto, CA
  • NPI 1013950807
  Medicare reassignment NPD
• Sutter Bay Medical Foundation

  dba Sutter East Bay Medical Foundation

  • Multi-Specialty Clinic/Center
  • Orinda, CA
  • NPI 1366898538
  NPD
• Sutter Bay Medical Foundation

  dba Palo Alto Medical Foundation

  • Clinical Medical Laboratory
  • Santa Clara, CA
  • NPI 1669287033
  NPD
• Eden Medical Center/San Leandro Hospital Campus

  dba San Leandro Hospital

  • Rehabilitation Hospital Unit
  • San Leandro, CA
  • NPI 1679523633
  NPD (past)
• Sutter East Bay Medical Foundation

  • Clinical Medical Laboratory
  • Berkeley, CA
  • NPI 1831381623
  NPD (past)
• Sutter West Bay Medical Foundation

  dba Sutter Pacific Medical Foundation

  • Family Medicine Physician
  • San Francisco, CA
  • NPI 1104852789

  Pediatrics

  NPD (past)
• Mountain View Hospital, Inc.

  dba Mountain View Hospital Continuing Care Center

  • Skilled Nursing Facility
  • Payson, UT
  • NPI 1295789279
  NPD (past)

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

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1184988008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 DISTEL CIR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940221408",
            "telephone_number": "510-886-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20101 LAKE CHABOT RD FL 3",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945465305",
            "telephone_number": "510-886-3400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4440 W 95th St",
            "address_purpose": "LOCATION",
            "city": "Oak Lawn",
            "state": "IL",
            "postal_code": "604532600",
            "country_code": "US",
            "telephone_number": "708-684-3296",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "919 2nd St NE",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "OH",
            "postal_code": "447041132",
            "country_code": "US",
            "telephone_number": "330-453-3386",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAUGHEN",
        "first_name": "KELLY",
        "middle_name": "MEAD",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-25",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "AC3890313-T050",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "20A22401",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036.137326",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "34.012728",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "270950",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Specialists Medical Group, Inc a Medical Corporation
• Bryan Gale Gatterman, D.C, D.A.C.B.R.
• Michelle Gayle, LMFT
• Warren Gee, MD
• General Vascular Surgery Medical Group, Inc. (Noninvasive Vascular Lab)
• Generation Home Health Agency
• Genesis Healthcare

• Pediatrics Physician in Castro Valley, CA
• Providers in Castro Valley, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.