Active NPI
Kara Camella Sanderson
- Clinical Social Worker
- Vacaville, CA
National Provider Identifier
1578092920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 107658
- Practice address
- 142 Vista View Dr
Vacaville, CA 95688-3537 - Phone
- (707) 628-2621
- NPI assigned
- Jun 8, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Clinical Social Worker | 1041C0700X | 107658 | CA | Primary |
Addresses
Primary practice location
142 Vista View Dr
Vacaville, CA 95688-3537
Mailing address
142 Vista View Dr
Vacaville, CA 95688-3537
Phone (707) 628-2621
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2017
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1 Optum Cir
Eden Prairie, MN 55344-2956
142 Vista View Dr
Vacaville, CA 95688-3537
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107658 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Psynergy Programs, Inc. | Clinical | Past | Accepting new patients |
| Psynergy Programs, Inc. | Clinical | Past | Accepting new patients |
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.
-
- Clinical Psychologist
- Rancho Cucamonga, CA
- NPI 1417718297
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720569600000",
"number": "1578092920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "142 VISTA VIEW DR",
"city": "VACAVILLE",
"state": "CA",
"postal_code": "956883537",
"telephone_number": "707-628-2621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "142 VISTA VIEW DR",
"city": "VACAVILLE",
"state": "CA",
"postal_code": "956883537",
"telephone_number": "707-628-2621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDERSON",
"first_name": "KARA",
"middle_name": "CAMELLA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-08",
"last_updated": "2024-07-10",
"certification_date": "2024-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "107658",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vacaville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 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.