Active NPI
Genesis Casco
- Physician Assistant
- Pomona, CA
National Provider Identifier
1295429215
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA63280
- Practice address
- 309 E 2ND St
Pomona, CA 91766-1854 - Phone
- (909) 623-6116
- NPI assigned
- Jun 5, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | |||
| Physician Assistant | 363A00000X | PA63280 | CA | Primary |
Addresses
Primary practice location
309 E 2ND St
Pomona, CA 91766-1854
Mailing address
8635 Bandera St
Los Angeles, CA 90002-1408
Phone (323) 774-2334
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231120001493 | CA | Order and Referring Only - Physician Assistant | 3072961747 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726790400000",
"number": "1295429215",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8635 BANDERA ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900021408",
"telephone_number": "323-774-2334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "309 E 2ND ST",
"city": "POMONA",
"state": "CA",
"postal_code": "917661854",
"telephone_number": "909-623-6116"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CASCO",
"first_name": "GENESIS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-05",
"last_updated": "2024-09-20",
"certification_date": "2024-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA63280",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pomona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.