Patricia Tu Gandasetiawan, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

55684 Issued in CA

Practice address

955 W Imperial Hwy Ste 110
Brea, CA 92821-3814

Phone

(714) 449-6900

NPI assigned

Jun 26, 2018

Last updated

Oct 7, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Chia-Chen Patricia Tu Former name

Electronic endpoints 1

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

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/3488/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762
  Medicare reassignment Care Compare group
• Providence Medical Foundation

  • Family Medicine Physician
  • Anaheim, CA
  • NPI 1609925957
  NPD
• Totalcare Walk in Clinic Inc

  • Internal Medicine Physician
  • Chino, CA
  • NPI 1760689715
  NPD (past)

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

{
    "created_epoch": "1529971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665100800000",
    "number": "1609361252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 W IMPERIAL HWY STE 110",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928213814",
            "telephone_number": "714-449-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 W IMPERIAL HWY STE 110",
            "city": "BREA",
            "state": "CA",
            "postal_code": "928213814",
            "telephone_number": "714-449-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANDASETIAWAN",
        "first_name": "PATRICIA",
        "middle_name": "TU",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-26",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "55684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ctu1374309@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "955 W Imperial Hwy",
            "city": "Brea",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928213812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "CHIA-CHEN",
            "last_name": "TU",
            "middle_name": "PATRICIA",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Celeste Marlene Galindo
• Rene Gallardo, LCSW, PPS
• Natalie Denise Galle
• Mark Gamalinda
• Julie Gamboa, RN
• Michelle Garces
• Taylor Jerae Garcia, DC
• Cynthia Diana Gardea
• Garfield Beach CVS LLC (CVS Pharmacy #17530)
• Garfield Beach CVS LLC (CVS Pharmacy # 11111)

• Physician Assistant in Brea, CA
• Providers in Brea, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2022; 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.