Individual provider Active NPI

Vasco D Kidd, PA

  • Physician Assistant
  • Orange, CA
National Provider Identifier
1396804019
Registry record updated Feb 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA16188 Issued in CA
Practice address
101 The City Dr S
Orange, CA 92868-3201
Phone
(714) 880-7812
NPI assigned
Dec 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA16188 CA Primary

Addresses

Primary practice location

101 The City Dr S
Orange, CA 92868-3201

Mailing address

200 S Manchester Ave Ste 300
Orange, CA 92868-3219
Phone (714) 456-2986

Other practice location 1

1901 W Lugonia Ave Ste 120
Redlands, CA 92374-9704
Phone (909) 557-1600

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050127000962 CA Practitioner - Physician Assistant 6507816469 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regents of the Univ of CaGroup PAC ID 3375456619, 1,571 clinicians

Practice addresses (Care Compare)

2221 Stockton Blvd
Sacramento, CA 95817-1418
Phone (916) 734-2680

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
83.7
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
16188CAMDMental Health Counselor
PA16188CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
San Bernardino Medical Orthopaedic Group, Inc. CurrentSince Oct 15, 2017 Accepting new patients
Regents of the Univ of Ca CurrentSince May 21, 2025 Accepting new patients
Regents of the Univ of Ca CurrentSince May 21, 2025 Accepting new patients
San Bernardino Medical Orthopaedic Group, Inc. CurrentSince Oct 15, 2017 Accepting new patients

Locations

1798 N Garey Ave
Pomona, CA 91767
Phone (909) 865-9810

1901 W Lugonia Ave
Ste 120
Redlands, CA 92374
Phone (909) 557-1626

1901 W Lugonia Ave
Ste 310
Redlands, CA 92374
Phone (909) 793-2964

4860 Y St
Ste 1700
Sacramento, CA 95817
Phone (916) 734-2700

2221 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-2680

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676937600000",
    "number": "1396804019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S MANCHESTER AVE STE 300",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683219",
            "telephone_number": "714-456-2986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 THE CITY DR S",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683201",
            "telephone_number": "714-880-7812"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1901 W Lugonia Ave Ste 120",
            "address_purpose": "LOCATION",
            "city": "Redlands",
            "state": "CA",
            "postal_code": "923749704",
            "country_code": "US",
            "telephone_number": "909-557-1600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIDD",
        "first_name": "VASCO",
        "middle_name": "D",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2023-02-21",
        "certification_date": "2023-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA16188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.