Caris Cassady
Individual provider Active NPI Physician Assistant · Fortuna, CA
NPI 1790299048 · NPPES record last updated Dec 3, 2021
Key facts
- NPI
- 1790299048
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 55162 (CA)
- Practice address
- 3300 Renner Dr
Fortuna, CA 95540-3120 - Phone
- (707) 725-3361
- NPI assigned
- Nov 23, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- University of Utah School of Medicine, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Providence Medical Foundation
Practice addresses (Care Compare)
200 W Ctr St Promenade
Anaheim, CA 92805-3960
3300 Renner Dr
Fortuna, CA 95540-3120
Phone (707) 725-3361
3304 Renner Dr
Fortuna, CA 95540-7102
Phone (714) 449-4800
500 Doyle Park Dr
Santa Rosa, CA 95405-4559
Hospital & facility affiliations
- Providence St Joseph Hospital
- Providence Redwood Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180226002398 | CA | Practitioner - Physician Assistant | 6305107848 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Medical Foundation | Current |
Accepting new patients | |
| Providence Medical Foundation | Current |
Accepting new patients | |
| Providence Medical Foundation | Past | Accepting new patients | |
| St. Joseph Health Northern California, LLC | Past | Accepting new patients |
Locations
200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841
3304 Renner Dr
Fortuna, CA 95540
Phone (707) 725-4477
3300 Renner Dr
Fortuna, CA 95540
Phone (707) 725-3361
1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210
500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 55162 | CA | Yes |
Addresses
Primary practice location
3300 Renner Dr
Fortuna, CA 95540-3120
Mailing address
3302 Renner Dr
Fortuna, CA 95540-7103
Phone (707) 725-3318
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ccassady1657548@oc.providencedirect.org | ||
| Direct Messaging Address | ccassady1657548@oc.providencedirect.org | ||
| Direct Messaging Address | ccassady1657548@oc.providencedirect.org |
Other providers in Fortuna, CA
- Christopher Joseph Campagna
- Cannamommy Holistic Botanicals, LLC
- Cannamommy.Org, Inc
- Erick Carrera
- Angelina Maria Carretero
- Marc Cavallo
- Center Community Pharmacy
- Cep America - California
- Susie PA Cha
- Karen G Chase
All providers in Fortuna, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.