Individual provider Active NPI

Jason Gillard, MSW

  • Clinical Social Worker
  • Canoga Park, CA
National Provider Identifier
1306927926
Registry record updated Nov 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
25769 Issued in CA
Practice address
21529 Saticoy St Apt 206
Canoga Park, CA 91304-4962
Phone
(818) 521-3867
NPI assigned
Oct 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 14881 CA
Clinical Social Worker 1041C0700X 25769 CA Primary

Addresses

Primary practice location

21529 Saticoy St Apt 206
Canoga Park, CA 91304-4962

Mailing address

21529 Saticoy St
Unit 206
Canoga Park, CA 91304-4958

Other practice location 1

11080 W Olympic Blvd
Los Angeles, CA 90064-1937
Phone (310) 966-6500

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
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
25769CAMDClinical Psychologist
14881CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince May 4, 2015 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Los Angeles County Department of Mental Health Current Accepting new patients
Southern California Permanente Medical Group CurrentSince May 4, 2015 Accepting new patients
Los Angeles County Department of Mental Health CurrentSince Mar 15, 2014 Accepting new patients
Los Angeles County Department of Mental Health CurrentSince Mar 15, 2014 Accepting new patients

Locations

11080 W Olympic Blvd
Los Angeles, CA 90064
Phone (310) 966-6500

5321 Via Marisol
Los Angeles, CA 90042
Phone (323) 474-6393

510 S Vermont Ave
Fl 19
Los Angeles, CA 90020
Phone (213) 480-3416

11080 W Olympic Blvd
Fl 1
Los Angeles, CA 90064
Phone (310) 966-6610

888 S Hill Rd
Ventura, CA 93003
Phone (805) 477-6400

5601 De Soto Ave
Woodland Hls, CA 91367
Phone (818) 719-2000

Organizations & group practices 6

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": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1306927926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21529 SATICOY ST",
            "address_2": "UNIT 206",
            "city": "CANOGA PARK",
            "state": "CA",
            "postal_code": "913044958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21529 SATICOY ST APT 206",
            "city": "CANOGA PARK",
            "state": "CA",
            "postal_code": "913044962",
            "telephone_number": "818-521-3867"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11080 W Olympic Blvd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900641937",
            "country_code": "US",
            "telephone_number": "310-966-6500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILLARD",
        "first_name": "JASON",
        "name_prefix": "Mr.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2021-11-29",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "14881",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "25769",
            "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": "5601 De Soto Ave",
            "city": "Woodland Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913676701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Canoga Park, CA

Sources for this page

Verify at the official NPI Registry.