Individual provider Active NPI

Jennifer C Mooney, PA-C

  • Physician Assistant
  • Palo Alto, CA
National Provider Identifier
1720117617
Registry record updated May 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA18167 Issued in CA
Practice address
795 El Camino Real
3Rd Floor
Palo Alto, CA 94301
Phone
(650) 853-2916
Fax
(650) 853-2852
NPI assigned
Mar 5, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA18167 CA Primary

Addresses

Primary practice location

795 El Camino Real
3Rd Floor
Palo Alto, CA 94301

Mailing address

325 Distel Cir
Los Altos, CA 94022-1408
Phone (650) 321-4121

Other names 1

  • Jennifer C Smith Former name

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081229000262 CA Practitioner - Physician Assistant 9032271069 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

Practice addresses (Care Compare)

100 S San Mateo Dr
San Mateo, CA 94401-3805
Phone (650) 696-5400

2500 Grant Rd
Mountain View, CA 94040-4302
Phone (650) 940-7000

50 S San Mateo Dr
San Mateo, CA 94401-3857
Phone (650) 652-8500

795 El Camino Real
Palo Alto, CA 94301-2302
Phone (415) 600-1020

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA18167CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sutter Bay Medical Foundation CurrentSince Apr 14, 2008 Accepting new patients
Sutter Bay Medical Foundation CurrentSince Apr 14, 2008 Accepting new patients
Sutter Bay Hospitals Past Accepting new patients
Sutter Bay Medical Foundation Past Accepting new patients
El Camino Hospital Past Accepting new patients

Locations

715 Altos Oaks Dr
Los Altos, CA 94024
Phone (650) 934-7010

325 Distel Cir
Los Altos, CA 94022
Phone (510) 204-3977

795 El Camino Real
Fl 3
Palo Alto, CA 94301
Phone (650) 853-2990

795 El Camino Real
Palo Alto, CA 94301
Phone (650) 324-1832

Interoperability endpoints

  • Direct secure messaging: jmooneypapmpa54896@hisp.ehr.sutterhealth.org

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590537600000",
    "number": "1720117617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 DISTEL CIR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940221408",
            "telephone_number": "650-321-4121",
            "fax_number": "650-853-2852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "795 EL CAMINO REAL",
            "address_2": "3RD FLOOR",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "94301",
            "telephone_number": "650-853-2916",
            "fax_number": "650-853-2852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOONEY",
        "first_name": "JENNIFER",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-05",
        "last_updated": "2020-05-27",
        "certification_date": "2020-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA18167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "SMITH",
            "middle_name": "C",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Palo Alto, CA

Sources for this page

Verify at the official NPI Registry.