Jamie Kehaulani Humphries Widger, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

15625 Imperial Hwy
La Mirada, CA 90638-1627

Phone

(562) 902-3000

Fax

(562) 902-9593

NPI assigned

Nov 10, 2023

Last updated

Jan 15, 2025By 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

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Imperial Primary Care Medical Group

  • Family Medicine Physician
  • La Mirada, CA
  • NPI 1598893455
  Medicare reassignment

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

{
    "created_epoch": "1699574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1053185918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15625 IMPERIAL HWY",
            "city": "LA MIRADA",
            "state": "CA",
            "postal_code": "906381627",
            "telephone_number": "562-902-3000",
            "fax_number": "562-902-9593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15625 IMPERIAL HWY",
            "city": "LA MIRADA",
            "state": "CA",
            "postal_code": "906381627",
            "telephone_number": "562-902-3000",
            "fax_number": "562-902-9593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMPHRIES WIDGER",
        "first_name": "JAMIE",
        "middle_name": "KEHAULANI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-10",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holy Home 2020 Inc. (Supercare Guest Home)
• Rachelle Honore
• Tina Rose Houston-Armstrong, PH.D.
• Jordan Hui, D.O.
• Tori Lynette Humphrey, DC
• Allison Ran Hur, PHARMD
• Hee Hur
• Sora Hwang
• Annette Hwangbo, LCSW
• Chiagoziem Igweze, RN

• Physician Assistant in La Mirada, CA
• Providers in La Mirada, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; 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.