Individual provider Active NPI

Mindy Duong

  • Emergency Medicine Physician
  • Fairfield, CA
National Provider Identifier
1720582604
Registry record updated Dec 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
166655 Issued in CA
Practice address
1200 B Gale Wilson Blvd
Fairfield, CA 94533-3552
Phone
(000) 000-0000
NPI assigned
Mar 23, 2018
Last updated
Dec 15, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Emergency Medicine Physician 207P00000X 166655 CA Primary

Addresses

Primary practice location

1200 B Gale Wilson Blvd
Fairfield, CA 94533-3552

Mailing address

1225 4TH St # 143
San Francisco, CA 94158-2249

Other practice location 1

505 Parnassus Ave
San Francisco, CA 94143-2204
Phone (858) 205-5744

Electronic endpoints 1

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

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230308000261 CA Practitioner - Emergency Medicine 9133524002 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1200 B Gale Wilson Blvd
Fairfield, CA 94533-3552
Phone (707) 429-3600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
166655CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northbay Healthcare Group CurrentSince Dec 2, 2022 Accepting new patients
Northbay Healthcare Group Current Accepting new patients
Northbay Physicians Surgery Center LLC Past Accepting new patients

Locations

1200 B Gale Wilson Blvd
Fairfield, CA 94533
Phone (707) 429-3600

4500 Business Center Dr
Fairfield, CA 94534
Phone (707) 646-4777

1000 Nut Tree Rd
Vacaville, CA 95687
Phone (707) 446-4000

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/UMZ-Uxn6V9x08sH5gCnG-5yPg9ZX7et6/

Organizations & group practices 3

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 1

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": "1521763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1720582604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 4TH ST # 143",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941582249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 B GALE WILSON BLVD",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945333552",
            "telephone_number": "000-000-0000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "505 Parnassus Ave",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941432204",
            "country_code": "US",
            "telephone_number": "858-205-5744",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUONG",
        "first_name": "MINDY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-23",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "166655",
            "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": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "250 Hospital Pkwy",
            "city": "San Jose",
            "state": "CA",
            "country_code": "US",
            "postal_code": "951191103",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fairfield, CA

Sources for this page

Verify at the official NPI Registry.