Moremi Abeni Gravesandy Vassall, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A177163 Issued in CA

Practice address

1480 64TH St Ste 150
Emeryville, CA 94608-2267

Phone

(925) 282-1778

Fax

(415) 296-5299

NPI assigned

Mar 22, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Specialty

Psychiatry

Education

Meharry Medical College School of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Pacific Coast Psychiatric Associates IncGroup PAC ID 2567469174, 637 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

95.17 of 100Reported as group

Quality

86.93

Promoting interoperability

100

Improvement activities

40

Cost

72.6

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.moremigravesandyvassall@148377.advancedmd-direct.com
• Direct secure messaging: mgravesandyvassall95683@alamedahs.direct-ci.com

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.

• Pacific Coast Psychiatric Associates Inc

  • Clinical Psychologist
  • Scottsdale, AZ
  • NPI 1023125465

  CA, Psychiatry

  Medicare reassignment Care Compare group NPD
• Alameda Health System

  • Surgery Physician
  • Oakland, CA
  • NPI 1740332931
  Medicare reassignment NPD
• Catholic Charities of Santa Clara County

  • Case Manager/Care Coordinator
  • San Jose, CA
  • NPI 1225155112
  Medicare reassignment NPD
• Contra Costa County

  • Adult Mental Health Clinic/Center
  • San Pablo, CA
  • NPI 1376620336
  Medicare reassignment NPD
• Alameda Health System

  • Federally Qualified Health Center (FQHC)
  • Newark, CA
  • NPI 1497956288
  NPD
• Catholic Charities of Santa Clara County

  • Voluntary or Charitable Agency
  • San Jose, CA
  • NPI 1700878154
  NPD
• Contra Costa County

  • General Acute Care Hospital
  • Martinez, CA
  • NPI 1386719086
  NPD

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

{
    "created_epoch": "1521676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715299200000",
    "number": "1407350663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1480 64TH ST STE 150",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946082267",
            "telephone_number": "925-282-1778",
            "fax_number": "415-296-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1480 64TH ST STE 150",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946082267",
            "telephone_number": "925-282-1778",
            "fax_number": "415-296-5299"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2060 Fairmont Dr",
            "address_purpose": "LOCATION",
            "city": "San Leandro",
            "state": "CA",
            "postal_code": "945781001",
            "country_code": "US",
            "telephone_number": "510-346-1300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAVESANDY VASSALL",
        "first_name": "MOREMI",
        "middle_name": "ABENI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-22",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "LA",
            "license": "321980",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A177163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melia Gonzales, BT
• Ruel Gonzales
• Maritza Aileen Gonzalez Torres
• Daisy Gonzalez
• Alicia Gravel
• Michael Richard Grazier, M.D.
• Jordana Green
• Jessica C Grier
• Bianca Naomi Griffith
• Gabriella Nicole Guerrero

• Psychiatry Physician in Emeryville, CA
• Providers in Emeryville, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.