Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Casey S Revenko, PHYSICIANASSISTANT

Individual provider Sports Medicine (Orthopaedic Surgery) Physician · NPI 1790341618

Casey S Revenko, PHYSICIANASSISTANT is a Physician Assistant in Oakland, California. Qualified in 2019, 7 years ago. Practices with Sutter Bay Medical Foundation, a 3,762-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
7
Licensed in
CA
In the registry since
2019
Specialties on file
2

Practice location Address checks out

350 30th St Ste 100
Oakland, CA 94609-3422
Phone: (510) 204-1844
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2999 Regent St Ste 225, Berkeley, CA 94705-2117 — (510) 704-7760

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA56633 (CA)
Sports Medicine (Orthopaedic Surgery) Physician Taxonomy 207XX0005X · Licence PA56633 (CA)

Record details

NPI number1790341618
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHYSICIANASSISTANT
Sole proprietorNo
NPI enumeratedMay 15, 2019
Last updated in NPPESDecember 31, 2024
Certification dateDecember 31, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Sutter Bay Medical Foundation — 3762 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations7 on file with Medicare

Other providers in Oakland