Jennifer Caserta, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD00043677 Issued in WA

Practice address

1911 Cooks Hill Rd
Centralia, WA 98531-9073

Phone

(360) 736-6778

Fax

(360) 736-6552

NPI assigned

Mar 28, 2007

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

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 8

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• N W Pediatric Center Inc P S

  • Pediatrics Physician
  • Chehalis, WA
  • NPI 1477789956
  NPD (past)
• N W Pediatric Center Inc P S

  dba Northwest Pediatric Center

  • Pediatrics Physician
  • Centralia, WA
  • NPI 1518034180
  NPD (past)
• N W Pediatric Center Inc P S

  dba Northwest Pediatric Center

  • Pediatrics Physician
  • Centralia, WA
  • NPI 1912515917
  NPD (past)
• Providence Health & Services Washington

  dba Providence Centralia Hospital

  • General Acute Care Hospital
  • Centralia, WA
  • NPI 1376624981
  NPD (past)

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1962521435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1911 COOKS HILL RD",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985319073",
            "telephone_number": "360-736-6778",
            "fax_number": "360-736-6552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1911 COOKS HILL RD",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985319073",
            "telephone_number": "360-736-6778",
            "fax_number": "360-736-6552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASERTA",
        "first_name": "JENNIFER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-28",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00043677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "2914CA",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "9116CA",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH",
            "identifier": "230532008",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7122617",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7057375",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7131709",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7131717",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8398356",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cascade Community Healthcare
• Cascade Community Healthcare (Cascade Mental Health Care)
• Cascade Evaluation and Treatment Center
• Cascade Family Medical Clinic Inc PS
• Jayson Lee Case
• Kevin T. Caserta, MD
• Amanda Marie Cashion, BSW, R-AAC
• Logan Alexander Cathro, PHARMD
• Donna Shirley Cawley, RDH
• Danielle Lynn Caywood, LMP

• Pediatrics Physician in Centralia, WA
• Providers in Centralia, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.