Keri S. H. Wardwell, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A106345 Issued in CA

Practice address

25825 Vermont Ave
Harbor City, CA 90710-3518

Phone

(310) 517-4083

NPI assigned

Aug 9, 2007

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

Other names 1

• Keri Sharona Hyatt Former name

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of California, Davis School of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Medical InstituteGroup PAC ID 5991609737, 303 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Little Co of Mary Med Ctr San Pedro Hospital, San Pedro, CA, CCN 050078

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: kwardwell313674@oc.providencedirect.org

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.

• Providence Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1417915760
  Medicare reassignment Care Compare group NPD
• Providence Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1235182569
  NPD
• Providence Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1760425862
  NPD

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

• Providence Health System - Southern California

  • General Acute Care Hospital
  • San Pedro, CA
  • NPI 1497241541
  Care Compare affiliation
• Providence Health System - Southern California

  • General Acute Care Hospital
  • San Pedro, CA
  • NPI 1942247291
  Care Compare affiliation

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

{
    "created_epoch": "1186617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618876800000",
    "number": "1104017573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1499 W 1ST ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323255",
            "telephone_number": "310-831-9482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25825 VERMONT AVE",
            "city": "HARBOR CITY",
            "state": "CA",
            "postal_code": "907103518",
            "telephone_number": "310-517-4083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARDWELL",
        "first_name": "KERI",
        "middle_name": "S. H.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-09",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A106345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwardwell313674@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1499 W 1st St",
            "city": "San Pedro",
            "state": "CA",
            "country_code": "US",
            "postal_code": "907323255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KERI",
            "last_name": "HYATT",
            "middle_name": "SHARONA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jeffrey L. Wang, MD
• Quincy C. Wang, MD
• Rick C Wang, OD
• Ziqing Victor Wang, M.D.
• Michael G. Ward, MD
• Nicole Shizu Watanabe
• Jason Joseph Waterman, M.D.
• Justin Bryan Weir, M.D.
• Richard Franklin Wells, PA
• Robert Weltman, MD

• Family Medicine Physician in Harbor City, CA
• Providers in Harbor City, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.