NPIMap

Individual provider Active NPI

Senan Isabelle Kakpo-Moore, PA-C

  • Physician Assistant
  • Victorville, CA
National Provider Identifier
1629670203
Registry record updated Aug 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60419 Issued in CA
Practice address
12998 Hesperia Rd Ste 204
Victorville, CA 92395-8317
Phone
(760) 780-4960
Fax
(760) 780-4964
NPI assigned
Nov 10, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X PA60419 CA Primary

Addresses

Primary practice location

12998 Hesperia Rd Ste 204
Victorville, CA 92395-8317

Mailing address

104 Woodmont Blvd Ste 500
Nashville, TN 37205-2245

Other names 1

  • Senan Isabelle Kakpo-Moore Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, MI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221208000360 CA Practitioner - Physician Assistant 4082083365 Reassigns benefits to 1 organization
I20260413001876 MI Practitioner - Physician Assistant 4082083365 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dignity HealthGroup PAC ID 2062320559, 88 clinicians

Practice addresses (Care Compare)

310 Hartnell Ave
Suite Aandc
Redding, CA 96002-1800
Phone (530) 245-2900

Hospital & facility affiliations

  • Mercy Medical Center Redding Hospital, Redding, CA, CCN 050280
  • Oroville Hospital Hospital, Oroville, CA, CCN 050030
  • Mercy Medical Center of Mt Shasta Hospital, Mount Shasta, CA, CCN 051319
  • St Elizabeth Community Hospital Hospital, Red Bluff, CA, CCN 050042
  • Mayers Memorial Hospital Hospital, Fall River Mills, CA, CCN 051305

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
89.27
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA60419CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Health CurrentSince Jan 16, 2025 Accepting new patients
Dignity Health CurrentSince Jan 16, 2025 Accepting new patients
Anchor Medical Group PastSince Aug 23, 2025 Accepting new patients
Dignity Health Past Accepting new patients

Locations

310 Hartnell Ave
Ste Ac
Redding, CA 96002
Phone (530) 225-6390

310 Hartnell Ave
Ste A
Redding, CA 96002
Phone (530) 245-2900

3400 Data Dr
Rncho Cordova, CA 95670
Phone (916) 379-2726

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1604966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693353600000",
    "number": "1629670203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 WOODMONT BLVD STE 500",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372052245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12998 HESPERIA RD STE 204",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923958317",
            "telephone_number": "760-780-4960",
            "fax_number": "760-780-4964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAKPO-MOORE",
        "first_name": "SENAN",
        "middle_name": "ISABELLE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-10",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA60419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SENAN",
            "last_name": "KAKPO-MOORE",
            "middle_name": "ISABELLE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.