NPIMap

Individual provider Active NPI

Jennifer Lee Gladden, MD

  • Emergency Medicine Physician
  • Quincy, CA
National Provider Identifier
1528077518
Registry record updated Sep 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
G60792 Issued in CA
Practice address
1065 Bucks Lake Rd
Quincy, CA 95971-9507
Phone
(530) 283-2121
Fax
(530) 283-3151
NPI assigned
Aug 7, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Personal Emergency Response Attendant 146D00000X G60792 CA
Emergency Medicine Physician 207P00000X G60792 CA Primary

Addresses

Primary practice location

1065 Bucks Lake Rd
Quincy, CA 95971-9507

Mailing address

1990 N California Blvd
Suite 400
Walnut Creek, CA 94596-3742
Phone (925) 225-5837

Other identifiers 2

IdentifierTypeStateIssuer
00G607920MedicaidCA
CA644ZMedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G60792CAMDPersonal Emergency Response Attendant

Practice roles

OrganizationSpecialtyStatusNew patients
Nor Cal Emergency Physicians Medical Group, Inc Emergency Medicine Past Accepting new patients
Dameron Emergency Physicians Medical Group, Inc. Emergency Medicine Past Accepting new patients
Lakeport Emergency Medical Corporation Emergency Medicine Past Accepting new patients
North Sonoma County Health Care District Past Accepting new patients
Memorial Emergency Physicians Medical Group, Inc Past Accepting new patients
Plumas District Hospital Past Accepting new patients

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": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411516800000",
    "number": "1528077518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1990 N CALIFORNIA BLVD",
            "address_2": "SUITE 400",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945963742",
            "telephone_number": "925-225-5837",
            "fax_number": "925-482-2834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1065 BUCKS LAKE RD",
            "city": "QUINCY",
            "state": "CA",
            "postal_code": "959719507",
            "telephone_number": "530-283-2121",
            "fax_number": "530-283-3151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLADDEN",
        "first_name": "JENNIFER",
        "middle_name": "LEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-07",
        "last_updated": "2014-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146D00000X",
            "taxonomy_group": "",
            "desc": "Personal Emergency Response Attendant",
            "state": "CA",
            "license": "G60792",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G60792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G607920",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CA644Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.