Gary Lynn Cavanaugh, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

C34330 Issued in CA

Practice address

2522 Grand Canal Blvd
#1
Stockton, CA 95207-8213

Phone

(209) 951-4666

Fax

(209) 951-5829

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Gary L Cavanaugh Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2016 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/e0d732aa-1d5c-42bf-b672-8fabe3feb437/

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.

• Inland Psychiatric Offices

  • Social Worker
  • Stockton, CA
  • NPI 1376668053
  NPD (past)
• Touro University Medical Group

  • Multi-Specialty Clinic/Center
  • Stockton, CA
  • NPI 1215573613

  Psychiatry

  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619087038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2522 GRAND CANAL BLVD",
            "address_2": "#1",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952078213",
            "telephone_number": "209-951-4666",
            "fax_number": "209-951-5829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2522 GRAND CANAL BLVD",
            "address_2": "#1",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952078213",
            "telephone_number": "209-951-4666",
            "fax_number": "209-951-5829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAVANAUGH",
        "first_name": "GARY",
        "middle_name": "LYNN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "C34330",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C343300",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GARY",
            "last_name": "CAVANAUGH",
            "middle_name": "L",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Stanley Ray Cathey, PA
• Catholic Charities
• Erwin Joshua Aurelio Catly, MA, BCBA
• Victor John Cattolico, PSY.D., PSY23576
• Cynthia Caughman
• Kevin Ronald Cavazos
• Gloria Cayabyab
• Lenee Joy Cayabyab, NURSE PRACTITIONER
• Monica Cazares, A.A SOCIOLOGY
• Ricardo Cazarez

• Psychiatry Physician in Stockton, CA
• Providers in Stockton, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.