Individual provider Active NPI

Dennis Kevin Caskey, LCSW

  • Clinical Social Worker
  • Cameron Park, CA
National Provider Identifier
1811279664
Registry record updated Jun 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
94853 Issued in CA
Practice address
3104 Ponte Morino Dr Ste 100
Cameron Park, CA 95682-8282
Phone
(305) 556-2056
NPI assigned
Sep 16, 2011
Last updated
Jun 24, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 94853 CA Primary

Addresses

Primary practice location

3104 Ponte Morino Dr Ste 100
Cameron Park, CA 95682-8282

Mailing address

3108 Ponte Morino Dr Ste 130
Cameron Park, CA 95682-8278
Phone (530) 556-2056

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240823001030 ID Practitioner - Clinical Social Worker 9931648870 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Full Circle Health IncGroup PAC ID 6709986797, 106 clinicians

Practice addresses (Care Compare)

6565 W Emerald St
Boise, ID 83704-8737
Phone (208) 514-2510

777 N Raymond St
Boise, ID 83704-9251
Phone (208) 514-2500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
94853CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
El Dorado County Community Health Center CurrentSince Sep 11, 2022 Accepting new patients
Full Circle Health, Inc. CurrentSince Jun 24, 2024 Accepting new patients

Locations

3104 Ponte Morino Dr
Ste 100
Cameron Park, CA 95682
Phone (305) 556-2056

777 N Raymond St
Boise, ID 83704
Phone (208) 367-6030

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Full Circle HealthNampa, ID, CCN 131885 Federally qualified health center Corporate Officer Jun 24, 2024
Full Circle Health IncCaldwell, ID, CCN 131055 Federally qualified health center Corporate Officer Jun 24, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1811279664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3108 PONTE MORINO DR STE 130",
            "city": "CAMERON PARK",
            "state": "CA",
            "postal_code": "956828278",
            "telephone_number": "530-556-2056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3104 PONTE MORINO DR STE 100",
            "city": "CAMERON PARK",
            "state": "CA",
            "postal_code": "956828282",
            "telephone_number": "305-556-2056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASKEY",
        "first_name": "DENNIS",
        "middle_name": "KEVIN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-16",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "94853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cameron Park, CA

Sources for this page

Verify at the official NPI Registry.