Active NPI
Keturah Braithwaite, PA-C
- Physician Assistant
- San Bernardino, CA
National Provider Identifier
1023773579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 61065
- Practice address
- 941 Kendall Dr Ste C
San Bernardino, CA 92407-4156 - Phone
- (302) 354-7476
- NPI assigned
- Nov 1, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 61065 | CA | Primary |
Addresses
Primary practice location
941 Kendall Dr Ste C
San Bernardino, CA 92407-4156
Mailing address
PO Box 90483
San Bernardino, CA 92427-1483
Phone (302) 354-7476
Other practice location 1
1533 West Merced Ave
suite 202
West Covina, CA 91790
Phone (302) 354-7476
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61065 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mobile Physicians Medical Allied Group Inc | Past | Accepting new patients |
Organizations & group practices 3
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.
-
dba Carbon Health
- Urgent Care Clinic/Center
- Berkeley, CA
- NPI 1417294232
-
- Primary Care Nurse Practitioner
- West Covina, CA
- NPI 1578019485
-
- Family Medicine Physician
- West Covina, CA
- NPI 1184199275
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1635724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687996800000",
"number": "1023773579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 90483",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924271483",
"telephone_number": "302-354-7476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "941 KENDALL DR STE C",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924074156",
"telephone_number": "302-354-7476"
}
],
"practiceLocations": [
{
"address_1": "1533 West Merced Ave",
"address_2": "suite 202",
"address_purpose": "LOCATION",
"city": "West Covina",
"state": "CA",
"postal_code": "91790",
"country_code": "US",
"telephone_number": "302-354-7476",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BRAITHWAITE",
"first_name": "KETURAH",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-11-01",
"last_updated": "2023-06-29",
"certification_date": "2023-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "61065",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; 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.