Individual provider Active NPI

Kevin Donaghy, M.D.

  • Emergency Medicine Physician
  • Folsom, CA
National Provider Identifier
1902014731
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A78703 Issued in CA
Practice address
1650 Creekside Dr
Folsom, CA 95630-3400
Phone
(916) 983-7400
NPI assigned
May 17, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 01087373A IN
Emergency Medicine Physician 207P00000X A78703 CA Primary

Addresses

Primary practice location

1650 Creekside Dr
Folsom, CA 95630-3400

Mailing address

1877 Clayton Way
Sacramento, CA 95835-1216
Phone (916) 233-9447

Other identifiers 1

IdentifierTypeStateIssuer
00A787030MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TX2 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

Enrollment IDStateProvider typePAC IDDetails
I20040519001480 CA Practitioner - Emergency Medicine 5294726162 Reassigns benefits to 2 organizations
I20240111002861 TX Practitioner - Emergency Medicine 5294726162 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. 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
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A78703CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Arctic Slope Native Association LTD Current Accepting new patients
Seneca Healthcare District CurrentSince Nov 3, 2022 Accepting new patients
Seneca Healthcare District Current Accepting new patients
Team Physicians of California Medical Group Inc Emergency Medicine CurrentSince Feb 15, 2011 Accepting new patients
Seneca Healthcare District CurrentSince Nov 3, 2022 Accepting new patients
Woodland Emergency Physicians Medical Group Inc Emergency Medicine Past Accepting new patients

Locations

975 S Fairmont Ave
Lodi, CA 95240
Phone (209) 339-7575

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1902014731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1877 CLAYTON WAY",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958351216",
            "telephone_number": "916-233-9447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 CREEKSIDE DR",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956303400",
            "telephone_number": "916-983-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONAGHY",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01087373A",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A78703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A787030",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Folsom, CA

Sources for this page

Verify at the official NPI Registry.