Active NPI
Marissa Caudill, MD, PHD
- Psychiatry Physician
- Woodland Hills, CA
National Provider Identifier
1578717468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A106990
- Practice address
- 21243 Ventura Blvd
Ste 243
Woodland Hills, CA 91364-2168 - Phone
- (424) 270-0744
- Fax
- (424) 270-0744
- NPI assigned
- Nov 5, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A106990 | CA | Primary |
Addresses
Primary practice location
21243 Ventura Blvd
Ste 243
Woodland Hills, CA 91364-2168
Mailing address
21243 Ventura Blvd
Ste 243
Woodland Hills, CA 91364-2168
Phone (424) 270-0744
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) | Southern California Permanente Medical Group |
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, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A106990 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638230400000",
"number": "1578717468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21243 VENTURA BLVD",
"address_2": "STE 243",
"city": "WOODLAND HILLS",
"state": "CA",
"postal_code": "913642168",
"telephone_number": "424-270-0744",
"fax_number": "424-270-0744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21243 VENTURA BLVD",
"address_2": "STE 243",
"city": "WOODLAND HILLS",
"state": "CA",
"postal_code": "913642168",
"telephone_number": "424-270-0744",
"fax_number": "424-270-0744"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAUDILL",
"first_name": "MARISSA",
"name_prefix": "Dr.",
"credential": "MD, PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-11-05",
"last_updated": "2021-11-30",
"certification_date": "2021-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A106990",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
"affiliation": "Y",
"endpointDescription": "Carequality",
"affiliationName": "Southern California Permanente Medical Group",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "C-CDA",
"address_1": "5601 De Soto Ave",
"city": "Woodland Hills",
"state": "CA",
"country_code": "US",
"postal_code": "913676701",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Woodland Hills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.