Scott Kevin Ishmael, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA18592 Issued in CA

Practice address

1350 Broadstone Pkwy
Appt 3622
Folsom, CA 95630-8478

Phone

(530) 409-5755

NPI assigned

Oct 11, 2007

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192060800000",
    "number": "1073701322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 BROADSTONE PKWY",
            "address_2": "APPT 3622",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956308478",
            "telephone_number": "530-409-5755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 BROADSTONE PKWY",
            "address_2": "APPT 3622",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956308478",
            "telephone_number": "530-409-5755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISHMAEL",
        "first_name": "SCOTT",
        "middle_name": "KEVIN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-11",
        "last_updated": "2007-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA18592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Folsom, CA
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 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.