Individual provider Active NPI

Lauren Fitzgerald

  • Physician Assistant
  • Vallejo, CA
National Provider Identifier
1407596166
Registry record updated Mar 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1310 Club Dr
Vallejo, CA 94592-1187
Phone
(707) 638-5809
NPI assigned
Mar 30, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 30, 2022

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 Primary

Addresses

Primary practice location

1310 Club Dr
Vallejo, CA 94592-1187

Mailing address

PO Box 3363
Blue Jay, CA 92317-3363

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
I20251002004222 CA Practitioner - Physician Assistant 9335645894 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Borrego Stat Care IncGroup PAC ID 1355888264, 4 clinicians
Homayoun Siman ApcGroup PAC ID 9931456779, 4 clinicians
Healing Hand Family Care Clinics CorpGroup PAC ID 3072821644, 5 clinicians

Practice addresses (Care Compare)

587 Palm Canyon Dr
Suite 215
Borrego SPGS, CA 92004-4000
Phone (760) 284-1044

73211 Fred Waring Dr
Suite 101
Palm Desert, CA 92260-2888
Phone (760) 837-0321

81800 Doctor Carreon Blvd
Suite a
Indio, CA 92201-5595
Phone (760) 342-4242

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
65094CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Borrego Stat Care Inc CurrentSince Apr 30, 2026 Accepting new patients

Locations

587 Palm Canyon Dr
Ste 215
Borrego Springs, CA 92004
Phone (760) 284-1044

73211 Fred Waring Dr
Ste 101
Palm Desert, CA 92260
Phone (760) 836-3835

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AHIICD/Endpoint/AHIICD

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": "1648598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648598400000",
    "number": "1407596166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3363",
            "city": "BLUE JAY",
            "state": "CA",
            "postal_code": "923173363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 CLUB DR",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945921187",
            "telephone_number": "707-638-5809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "LAUREN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-30",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vallejo, CA

Sources for this page

Verify at the official NPI Registry.