Individual provider Active NPI

Jason Paul Karageorge, PHD

  • Psychologist
  • Nicasio, CA
National Provider Identifier
1649576166
Registry record updated Jan 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
24025 Issued in CA
Practice address
7349 Lucas Valley Rd
Nicasio, CA 94946-9720
Phone
(415) 385-2847
NPI assigned
Jan 31, 2011
Last updated
Jan 3, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 24025 CA Primary

Addresses

Primary practice location

7349 Lucas Valley Rd
Nicasio, CA 94946-9720

Mailing address

7349 Lucas Valley Rd
Nicasio, CA 94946-9720
Phone (415) 385-2847

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131106000920 CA Practitioner - Clinical Psychologist 4082849609 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
24025CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group Inc Current Accepting new patients
Permanente Medical Group Inc CurrentSince Jul 21, 2013 Accepting new patients

Locations

750 Auburn Ravine Rd
Auburn, CA 95603
Phone (530) 823-6131

5820 Owens Dr
Bldg E
Pleasanton, CA 94588
Phone (925) 737-3785

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

1400 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-4338

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

501 J St
Sacramento, CA 95814
Phone (916) 497-3000

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

5615 Scotts Valley Dr
Scotts Valley, CA 95066
Phone (831) 430-2700

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1296432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1649576166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7349 LUCAS VALLEY RD",
            "city": "NICASIO",
            "state": "CA",
            "postal_code": "949469720",
            "telephone_number": "415-385-2847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7349 LUCAS VALLEY RD",
            "city": "NICASIO",
            "state": "CA",
            "postal_code": "949469720",
            "telephone_number": "415-385-2847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KARAGEORGE",
        "first_name": "JASON",
        "middle_name": "PAUL",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-01-31",
        "last_updated": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "24025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1400 Veterans Blvd",
            "city": "Redwood City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "940632612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Nicasio, CA

Sources for this page

Verify at the official NPI Registry.