Individual provider Active NPI

Donald Philip Gallo, PH.D.

  • Clinical Child & Adolescent Psychologist
  • Woodland Hills, CA
National Provider Identifier
1225056419
Registry record updated Oct 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
PSY16889 Issued in CA
Practice address
21241 Ventura Blvd
Suite 180
Woodland Hills, CA 91364-2108
Phone
(818) 472-2029
NPI assigned
Jul 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X PSY16889 CA Primary

Addresses

Primary practice location

21241 Ventura Blvd
Suite 180
Woodland Hills, CA 91364-2108

Mailing address

21241 Ventura Blvd
Suite 180
Woodland Hills, CA 91364-2108
Phone (818) 472-2029

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California 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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130904000988 CA Practitioner - Clinical Psychologist 5991948200 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

12669 Encinitas Ave
Sylmar, CA 91342-3635
Phone (877) 608-0044

13652 Cantara St
Panorama City, CA 91402-5423
Phone (818) 375-2000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
16889CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Jun 29, 2013 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jun 29, 2013 Accepting new patients

Locations

13652 Cantara St
Panorama City, CA 91402
Phone (818) 375-2417

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633305600000",
    "number": "1225056419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21241 VENTURA BLVD",
            "address_2": "SUITE 180",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913642108",
            "telephone_number": "818-472-2029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21241 VENTURA BLVD",
            "address_2": "SUITE 180",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913642108",
            "telephone_number": "818-472-2029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLO",
        "first_name": "DONALD",
        "middle_name": "PHILIP",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CA",
            "license": "PSY16889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "13652 Cantara St",
            "city": "Panorama City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "914025423",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Woodland Hills, CA

Sources for this page

Verify at the official NPI Registry.