Active NPI
Stacy J Berrong, DO
- Family Medicine Physician
- Woodland, CA
National Provider Identifier
1760407787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 20A8432
- Practice address
- 632 W Gibson Rd
Woodland, CA 95695 - Phone
- (530) 666-1631
- Fax
- (530) 668-2697
- NPI assigned
- Jul 12, 2006
- Last updated
- Nov 18, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 20A8432 | CA | Primary |
| Obstetrics Physician | 207VX0000X | 20A8432 | CA |
Addresses
Primary practice location
632 W Gibson Rd
Woodland, CA 95695
Mailing address
3400 Data Dr 1St
Rancho Cordova, CA 95670-7956
Phone (916) 379-2861
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020A84320 | Other | CA | BLUE SHIELD |
| P00745159 | Other | CA | MEDICARE RAILROAD |
| 00AX84320 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 2001
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
207 N Butte St
Willows, CA 95988-2803
Phone (530) 934-9293
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A8432 | CA | MD | Obstetrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northern Valley Indian Health Inc | Current | Accepting new patients | |
| Northern Valley Indian Health Inc | Current | Accepting new patients | |
| Afato Medical Corporation | Family Medicine | Past | Accepting new patients |
| Regency Urgent Care Medical Corp | Family Medicine | Past | Accepting new patients |
Locations
207 N Butte St
Willows, CA 95988
Phone (530) 934-4641
1280 E Gibson Rd
Woodland, CA 95776
Phone (530) 650-4500
175 W Court St
Woodland, CA 95695
Phone (530) 661-4400
Interoperability endpoints
- stacy.berrong@nvih.eclinicaldirectplus.com
Organizations & group practices 4
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.
-
- Clinic/Center
- Chico, CA
- NPI 1750031548
-
dba Regency Urgent Care
- Family Medicine Physician
- Yuba City, CA
- NPI 1134142524
-
- Urgent Care Clinic/Center
- Yuba City, CA
- NPI 1356394480
Family Medicine
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Woodland Healthcare Home Health
- Home Health Agency
- Woodland, CA
- NPI 1851494231
-
dba Woodland Memorial Hospital
- General Acute Care Hospital
- Woodland, CA
- NPI 1922116037
-
dba Aspire Home Healthcare of Northern California
- Home Health Agency
- Yuba City, CA
- NPI 1144645813
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447804800000",
"number": "1760407787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 DATA DR 1ST",
"city": "RANCHO CORDOVA",
"state": "CA",
"postal_code": "956707956",
"telephone_number": "916-379-2861",
"fax_number": "916-858-3205"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "632 W GIBSON RD",
"city": "WOODLAND",
"state": "CA",
"postal_code": "95695",
"telephone_number": "530-666-1631",
"fax_number": "530-668-2697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERRONG",
"first_name": "STACY",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-12",
"last_updated": "2015-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "20A8432",
"primary": true
},
{
"code": "207VX0000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Obstetrics",
"state": "CA",
"license": "20A8432",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "020A84320",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "P00745159",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00AX84320",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2015; 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.