Individual provider Active NPI

Kevin S Mould, M.D.

  • Family Medicine Physician
  • Davis, CA
National Provider Identifier
1255351748
Registry record updated Oct 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A90920 Issued in CA
Practice address
2330 W Covell Blvd
Davis, CA 95616-5658
Phone
(530) 756-2364
Fax
(530) 756-5817
NPI assigned
Jul 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A90920 CA Primary

Addresses

Primary practice location

2330 W Covell Blvd
Davis, CA 95616-5658

Mailing address

2330 W Covell Blvd
Davis, CA 95616-5658
Phone (530) 756-2364

Other identifiers 3

IdentifierTypeStateIssuer
00A909200MedicaidCA
P00284495OtherCARR MEDICARE
00A909200OtherCABLUE SHIELD

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051031000937 CA Practitioner - Family Practice 9032136809 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York Medical College, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Neighborhood HealthcareGroup PAC ID 5294649406, 153 clinicians

Practice addresses (Care Compare)

855 E Madison Ave
El Cajon, CA 92020-3819
Phone (619) 440-2751

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Neighborhood Healthcare General Practice CurrentSince Aug 14, 2018 Accepting new patients
Neighborhood Healthcare General Practice CurrentSince Aug 14, 2018 Accepting new patients
Dignity Community Care Past Accepting new patients
Piney Woods Healthcare System LP Past Accepting new patients

Locations

855 E Madison Ave
El Cajon, CA 92020
Phone (619) 440-2751

425 N Date St
#0
Escondido, CA 92025

425 N Date St
Escondido, CA 92025
Phone (760) 737-2035

13010 Poway Rd
Poway, CA 92064
Phone (858) 218-3000

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

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": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383091200000",
    "number": "1255351748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 W COVELL BLVD",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956165658",
            "telephone_number": "530-756-2364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 W COVELL BLVD",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956165658",
            "telephone_number": "530-756-2364",
            "fax_number": "530-756-5817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOULD",
        "first_name": "KEVIN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2013-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A90920",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A909200",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00284495",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00A909200",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davis, CA

Sources for this page

Verify at the official NPI Registry.