Individual provider Active NPI

Misty Phommatheth, DNP, CNM, WHNP-BC

  • Advanced Practice Midwife
  • Oroville, CA
National Provider Identifier
1083326375
Registry record updated Jun 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
236351 Issued in CA
Practice address
2767 Olive Hwy
Oroville, CA 95966-6118
Phone
(530) 533-8500
NPI assigned
Dec 19, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X 236351 CA Primary

Addresses

Primary practice location

2767 Olive Hwy
Oroville, CA 95966-6118

Mailing address

8816 Waterview Rd
Machesney Park, IL 61115-2035

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231010002037 CA Practitioner - Certified Nurse Midwife (CNM) 2163877275 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Nurse Midwife (CNM)
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

18600 S Figueroa St
Gardena, CA 90248-4505
Phone (310) 325-5111

25821 Vermont Ave
Harbor City, CA 90710-3518
Phone (310) 325-5111

25825 Vermont Ave
Harbor City, CA 90710-3518
Phone (310) 325-5111

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
236351CAMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Orohealth Corporation a Non Profit Healthcare System CurrentSince Aug 28, 2023 Accepting new patients
Southern California Permanente Medical Group CurrentSince May 13, 2025 Accepting new patients
Southern California Permanente Medical Group CurrentSince May 13, 2025 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

25825 Vermont Ave
Harbor City, CA 90710
Phone (310) 325-5111

2767 Olive Hwy
Oroville, CA 95966
Phone (916) 533-8500

2809 Olive Hwy
Oroville, CA 95966
Phone (530) 532-8654

2767 Olive Hwy
#260
Oroville, CA 95966
Phone (530) 532-8544

2721 Olive Hwy
Ste 4
Oroville, CA 95966
Phone (530) 532-8161

2809 Olive Hwy
Ste 310
Oroville, CA 95966
Phone (530) 532-8584

2809 Olive Hwy
Ste 320
Oroville, CA 95966
Phone (530) 532-8181

2809 Olive Hwy
Ste 250
Oroville, CA 95966
Phone (530) 532-7650

393 E Walnut St
Fl 5
Pasadena, CA 91188
Phone (310) 403-3235

Organizations & group practices 4

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": "1671408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750982400000",
    "number": "1083326375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8816 WATERVIEW RD",
            "city": "MACHESNEY PARK",
            "state": "IL",
            "postal_code": "611152035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2767 OLIVE HWY",
            "city": "OROVILLE",
            "state": "CA",
            "postal_code": "959666118",
            "telephone_number": "530-533-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHOMMATHETH",
        "first_name": "MISTY",
        "credential": "DNP, CNM, WHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-19",
        "last_updated": "2025-06-27",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "CA",
            "license": "236351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "25825 Vermont Ave",
            "city": "Harbor City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "907103518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Oroville, CA

Sources for this page

Verify at the official NPI Registry.