NPIMap

Individual provider Active NPI

Tiffany Penhallurick, PA-C

  • Physician Assistant
  • Hemet, CA
National Provider Identifier
1083952147
Registry record updated Jan 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA22727 Issued in CA
Practice address
1600 E Florida Ave
Hemet, CA 92544-8643
Phone
(951) 765-1766
NPI assigned
Jan 24, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2013

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 PA22727 CA Primary

Addresses

Primary practice location

1600 E Florida Ave
Hemet, CA 92544-8643

Mailing address

1600 E Florida Ave
Hemet, CA 92544-8643
Phone (951) 765-1766

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151207002340 CA Practitioner - Physician Assistant 3072813179 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Memorial Health SystemGroup PAC ID 9537155676, 187 clinicians

Practice addresses (Care Compare)

147 N Brent St
Ventura, CA 93003-2809
Phone (805) 652-5011

2361 E Vineyard Ave
Oxnard, CA 93036-2102
Phone (805) 981-3770

Hospital & facility affiliations

  • Community Memorial Hospital - Ventura Hospital, Ventura, CA, CCN 050394

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
22727CAMDOccupational Therapist
PA22727CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Community Memorial Health System CurrentSince Jul 1, 2022 Accepting new patients
Community Memorial Health System CurrentSince Jul 1, 2022 Accepting new patients
Valley OB/GYN Medical Group,Inc. Past Accepting new patients
Neighborhood Healthcare PastSince Feb 1, 2020 Accepting new patients

Locations

422 Arneill Rd
Ste B
Camarillo, CA 93010
Phone (805) 383-4510

2921 Saviers Rd
Oxnard, CA 93033
Phone (805) 487-5588

5855 Olivas Park Dr
Ventura, CA 93003
Phone (805) 652-5469

138 W Main St
Ste E
Ventura, CA 93001
Phone (805) 667-2850

147 N Brent St
Ventura, CA 93003
Phone (805) 652-5011

Interoperability endpoints

  • Direct secure messaging: tiffanypenhallurick@cfh.allscriptsdirect.net
  • Direct secure messaging: tpenhallurick3518473@oc.providencedirect.org

Organizations & group practices 5

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1358985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358985600000",
    "number": "1083952147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 E FLORIDA AVE",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925448643",
            "telephone_number": "951-765-1766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 E FLORIDA AVE",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925448643",
            "telephone_number": "951-765-1766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENHALLURICK",
        "first_name": "TIFFANY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-24",
        "last_updated": "2013-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA22727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hemet, CA

Sources for this page

Verify at the official NPI Registry.