Jeffrey O McGillicuddy, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

G84589 Issued in CA

Practice address

1234 E North St
Suite 103
Manteca, CA 95336-4960

Phone

(209) 647-3101

Fax

(209) 529-8378

NPI assigned

Sep 13, 2006

Last updated

Feb 11, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA, OR2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: 800786@lake.cernerdirect.com
• Direct secure messaging: jmcgillicuddy230199@hisp.ehr.sutterhealth.org

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.

• North Pacific Cardiology Medical

  • Internal Medicine Physician
  • Arcata, CA
  • NPI 1093821837
  Medicare reassignment NPD
• Orchard Hospital

  • Critical Access Hospital
  • Gridley, CA
  • NPI 1477522019
  Medicare reassignment NPD
• Seneca Healthcare District

  • Medicare Defined Swing Bed Hospital Unit
  • Chester, CA
  • NPI 1326234022
  Medicare reassignment NPD
• Samaritan Pacific Health Services, Inc

  dba Samaritan Pacific Communities Hospital

  • Critical Access Hospital
  • Newport, OR
  • NPI 1801847066
  Medicare reassignment NPD
• Samaritan Pacific Health Services, Inc.

  dba Samaritan Medical Group Occupational Medicine - Newport

  • Physical Medicine & Rehabilitation Physician
  • Newport, OR
  • NPI 1174888010
  Medicare reassignment NPD
• Synergy Surgicalists PC

  • Orthopaedic Surgery Physician
  • Grass Valley, CA
  • NPI 1932623782
  Medicare reassignment
• Seneca Healthcare District

  dba Lake Almanor Clinic

  • Rural Health Clinic/Center
  • Chester, CA
  • NPI 1104920438
  NPD
• Seneca Healthcare District

  • Critical Access Hospital
  • Chester, CA
  • NPI 1396848677
  NPD
• Samaritan Pacific Health Services, Inc

  dba Samaritan Kidney Specialists - Newport

  • Rural Health Clinic/Center
  • Depoe Bay, OR
  • NPI 1164781142
  NPD
• Anesthesia Associates Northwest LLC

  • Anesthesiology Physician
  • Milwaukie, OR
  • NPI 1548281751
  NPD (past)

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613001600000",
    "number": "1871698993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 REYNOLDS ROAD",
            "city": "CHESTER",
            "state": "CA",
            "postal_code": "96020",
            "telephone_number": "530-258-2826",
            "fax_number": "530-258-2802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1234 E NORTH ST",
            "address_2": "SUITE 103",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953364960",
            "telephone_number": "209-647-3101",
            "fax_number": "209-529-8378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCGILLICUDDY",
        "first_name": "JEFFREY",
        "middle_name": "O",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2021-02-11",
        "certification_date": "2021-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "G84589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G845890",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500665638",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "800786@lake.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Lake District Hospital Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "700 S J St",
            "city": "Lakeview",
            "state": "OR",
            "country_code": "US",
            "postal_code": "976301623",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Matthew Kim Dental Corp (Walnut Plaza Dental)
• Brianna Maxey
• Jade Hannah McBride
• Teresa McClendon
• Cassandra June McCurdy, MSN,NP-C
• McHenry Medical Group, Inc.
• Alicia Dawn McLelland, MPT
• April Anne McNichols, LCSW, MSW
• Jeffrey Meath, RPH
• Phylicia Nicole Medeiros, SCHOOL PSYCHOLOGY

• Orthopaedic Surgery Physician in Manteca, CA
• Providers in Manteca, CA by specialty
• Orthopaedic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.