Individual provider Active NPI

Mously Diakhate, PA-C

  • Physician Assistant
  • San Pablo, CA
National Provider Identifier
1811407265
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
54961 Issued in CA
Practice address
2023 Vale Rd
San Pablo, CA 94806-3834
Phone
(510) 231-9800
NPI assigned
Oct 11, 2017
Last updated
Mar 23, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 54961 CA Primary

Addresses

Primary practice location

2023 Vale Rd
San Pablo, CA 94806-3834

Mailing address

2023 Vale Road
San Pablo, CA 94806
Phone (510) 231-9800

Other practice location 1

1411 E 31st St
Oakland, CA 94602-1018
Phone (510) 437-4800

Other identifiers 1

IdentifierTypeStateIssuer
54961OtherCALICENSE

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181101001148 CA Practitioner - Physician Assistant 7810240298 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
96.69 of 100Reported as group
Quality
90
Improvement activities
40
Cost
78.43

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
54961CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Lifelong Medical Care CurrentSince Aug 25, 2018 Accepting new patients
Cep America - California CurrentSince Mar 24, 2023 Accepting new patients
Lifelong Medical Care CurrentSince Aug 25, 2018 Accepting new patients
Cep America-California CurrentSince Mar 24, 2023 Accepting new patients
RTW Health Services LLC Past Accepting new patients

Locations

2344 6th St
Berkeley, CA 94710
Phone (510) 981-3203

2755 Herndon Ave
Clovis, CA 93611
Phone (559) 323-4000

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1650 Creekside Dr
Folsom, CA 95630
Phone (916) 983-7400

10700 MacArthur Blvd
Ste 14B
Oakland, CA 94605
Phone (510) 563-4300

4445 Magnolia Ave
Riverside, CA 92501
Phone (800) 498-7156

15031 Rinaldi St
San Fernando, CA 91345
Phone (818) 365-8051

Interoperability endpoints

  • Direct secure messaging: mdiakhate559437@hisp.ehr.sutterhealth.org

Organizations & group practices 10

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": "1507680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1811407265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2023 VALE ROAD",
            "city": "SAN PABLO",
            "state": "CA",
            "postal_code": "94806",
            "telephone_number": "510-231-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2023 VALE RD",
            "city": "SAN PABLO",
            "state": "CA",
            "postal_code": "948063834",
            "telephone_number": "510-231-9800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1411 E 31st St",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946021018",
            "country_code": "US",
            "telephone_number": "510-437-4800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIAKHATE",
        "first_name": "MOUSLY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-11",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "54961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "54961",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Pablo, CA

Sources for this page

Verify at the official NPI Registry.