Individual provider Active NPI

Yolanda Zamora Agredano de Moreno, M.D.

  • Psychiatry Physician
  • San Jose, CA
National Provider Identifier
1750575874
Registry record updated Aug 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A96450 Issued in CA
Practice address
614 Tully Rd
San Jose, CA 95111-1048
Phone
(408) 494-1561
NPI assigned
Aug 31, 2007
Last updated
Aug 21, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X A96450 CA Primary

Addresses

Primary practice location

614 Tully Rd
San Jose, CA 95111-1048

Mailing address

614 Tully Rd
San Jose, CA 95111-1048
Phone (408) 494-1561

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
I20090509000043 CA Practitioner - Psychiatry 2365590965 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Stanford University School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of Santa ClaraGroup PAC ID 1254244973, 1,000 clinicians

Practice addresses (Care Compare)

1991 McKee Rd
San Jose, CA 95116-1406
Phone (408) 885-7366

1993 McKee Rd
San Jose, CA 95116-1406
Phone (408) 885-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
61 of 100Reported as group
Quality
59.41
Promoting interoperability
0
Improvement activities
40
Cost
71.45

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A96450CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Santa Clara CurrentSince Aug 25, 2019 Accepting new patients
Cardinal Wellness, Inc. Psychiatry Current Accepting new patients
County of Santa Clara CurrentSince Aug 13, 2011 Accepting new patients
County of Santa Clara CurrentSince Aug 13, 2011 Accepting new patients

Locations

7475 Camino Arroyo
Gilroy, CA 95020
Phone (408) 852-2400

1996 Lundy Ave
San Jose, CA 95131
Phone (408) 299-5846

2101 Alexian Dr
San Jose, CA 95116
Phone (408) 272-6050

750 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-2320

751 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-5110

Interoperability endpoints

  • Direct secure messaging: yagredanodemoreno10150@santaclaravalley.direct-ci.net
  • Direct secure messaging: yolanda.agredano.1@23523.direct.athenahealth.com

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, 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": "1188518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282348800000",
    "number": "1750575874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 TULLY RD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951111048",
            "telephone_number": "408-494-1561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 TULLY RD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951111048",
            "telephone_number": "408-494-1561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGREDANO DE MORENO",
        "first_name": "YOLANDA",
        "middle_name": "ZAMORA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-31",
        "last_updated": "2010-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A96450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.