Individual provider Active NPI

Cassidy V Gagnon

  • Pediatrics Physician
  • Pleasanton, CA
National Provider Identifier
1366716649
Registry record updated Feb 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A137759 Issued in CA
Practice address
7601 Stoneridge Dr
Pleasanton, CA 94588-4501
Phone
(385) 841-5050
NPI assigned
Mar 3, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A137759 CA Primary

Addresses

Primary practice location

7601 Stoneridge Dr
Pleasanton, CA 94588-4501

Mailing address

8262 N Lake Dr Apt C
Dublin, CA 94568-3784

Other names 1

  • Cassidy Vuong Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The 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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171009001704 CA Practitioner - Pediatric Medicine 3476828161 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A137759CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group Inc Pediatrics CurrentSince Aug 21, 2017 Accepting new patients
Permanente Medical Group Inc Pediatrics Current Accepting new patients
Permanente Medical Group, Inc CurrentSince Aug 21, 2017 Accepting new patients

Locations

750 Auburn Ravine Rd
Auburn, CA 95603
Phone (530) 823-6131

4753 W Shaw Ave
Ste 101
Fresno, CA 93722
Phone (559) 277-8738

900 N Douty St
Hanford, CA 93230
Phone (559) 587-9014

1800 Harrison St
Fl 7
Oakland, CA 94612

101 Monroe St
Petaluma, CA 94954
Phone (707) 763-4109

7601 Stoneridge Dr
Pleasanton, CA 94588
Phone (925) 847-5000

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

930 W Main St
Ripon, CA 95366
Phone (209) 599-4221

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

5615 Scotts Valley Dr
Scotts Valley, CA 95066
Phone (831) 430-2700

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

320 N Crawford St
Willows, CA 95988
Phone (530) 934-2834

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": "1330732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644537600000",
    "number": "1366716649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8262 N LAKE DR APT C",
            "city": "DUBLIN",
            "state": "CA",
            "postal_code": "945683784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 STONERIDGE DR",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945884501",
            "telephone_number": "385-841-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAGNON",
        "first_name": "CASSIDY",
        "middle_name": "V",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-03",
        "last_updated": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A137759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "7601 Stoneridge Drive",
            "city": "Pleasanton",
            "state": "CA",
            "country_code": "US",
            "postal_code": "94588",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CASSIDY",
            "last_name": "VUONG",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Pleasanton, CA

Sources for this page

Verify at the official NPI Registry.