Individual provider Active NPI

Kristine Himmerick, PA

  • Physician Assistant
  • Napa, CA
National Provider Identifier
1073514840
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA18597 Issued in CA
Practice address
1141 Pear Tree LN Ste 100
Napa, CA 94558-6485
Phone
(707) 254-1770
NPI assigned
Aug 3, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA18597 CA Primary

Addresses

Primary practice location

1141 Pear Tree LN Ste 100
Napa, CA 94558-6485

Mailing address

2555 Flosden Rd SPC 98
American Canyon, CA 94503-3924
Phone (970) 240-3395

Other identifiers 1

IdentifierTypeStateIssuer
61674257MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA18597CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Solano Emergency Medical Group, Inc Physician Assistant Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: khimmerick826997@direct.ochin.org

Organizations & group practices 1

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": "1123027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073514840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2555 FLOSDEN RD SPC 98",
            "city": "AMERICAN CANYON",
            "state": "CA",
            "postal_code": "945033924",
            "telephone_number": "970-240-3395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1141 PEAR TREE LN STE 100",
            "city": "NAPA",
            "state": "CA",
            "postal_code": "945586485",
            "telephone_number": "707-254-1770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HIMMERICK",
        "first_name": "KRISTINE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA18597",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "61674257",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Napa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.