Ashley Ryan Vidad, DO

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

4441 Tiamo Way
Stockton, CA 95212-2792

Phone

(650) 307-7903

NPI assigned

Mar 26, 2022

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

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kaiser Foundation Hospital, Riverside Hospital, Riverside, CA, CCN 050686

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

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.

• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Riverside, CA
  • NPI 1316979834
  Medicare reassignment Care Compare group NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Hemet, CA
  • NPI 1013433465
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD

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

• Kaiser Foundation Hospitals

  • General Acute Care Hospital
  • Riverside, CA
  • NPI 1306991211
  Care Compare affiliation

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

{
    "created_epoch": "1648252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1689324212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4441 TIAMO WAY",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952122792",
            "telephone_number": "650-307-7903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4441 TIAMO WAY",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952122792",
            "telephone_number": "650-307-7903"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1102 Lyons St",
            "address_purpose": "LOCATION",
            "city": "Redwood City",
            "state": "CA",
            "postal_code": "940612263",
            "country_code": "US",
            "telephone_number": "650-307-7903",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VIDAD",
        "first_name": "ASHLEY RYAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-26",
        "last_updated": "2022-07-25",
        "certification_date": "2022-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "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": "10800 Magnolia Ave",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925053043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Arnold Vial
• Shauntrell Sheri Vickers
• Victor Community Support Services, Inc.
• Victor Y. Ho, O.D. a Professional Corporation
• Catherine Briana Victoriano
• Ivy Glaze Vidad
• Shakila Vidal
• Yanelli Vidauri
• Natalie Nacole Vides-Boelke, LCSW
• Angela Vanessa Vides

• Student in an Organized Health Care Education/Training Program in Stockton, CA
• Providers in Stockton, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 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.