Individual provider Active NPI

Pamela Mikkelsen, DPT

  • Orthopedic Physical Therapist
  • Los Angeles, CA
National Provider Identifier
1104220722
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
41726 Issued in CA
Practice address
1031 W 34TH St Ste 450
Los Angeles, CA 90089-3603
Phone
(213) 740-0215
NPI assigned
Oct 9, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 41726 CA Primary

Addresses

Primary practice location

1031 W 34TH St Ste 450
Los Angeles, CA 90089-3603

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (213) 740-0215

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pamela.mikkelsen@direct.usc.edu Direct USC CARE MEDICAL GROUP, INC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150202001123 CA Practitioner - Physical Therapist in Private Practice 0345565958 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
41726CAMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Usc Care Medical Group, Inc CurrentSince Nov 5, 2019 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Nov 5, 2019 Accepting new patients
Usc University Hospital, Inc. Past Accepting new patients
Usc Verdugo Hills Hospital, LLC Past Accepting new patients
Keck Medical Center of Usc Past Accepting new patients

Locations

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

1640 Marengo St
Ste 102
Los Angeles, CA 90033
Phone (323) 224-7070

1640 Marengo St
Los Angeles, CA 90033
Phone (323) 223-4091

1031 W 34th St
Ste 450
Los Angeles, CA 90089
Phone (213) 740-0215

1031 W 34th St
Los Angeles, CA 90089
Phone (213) 740-7711

Interoperability endpoints

  • Direct secure messaging: pamela.mikkelsen@direct.usc.edu

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.

NPI Registry JSON

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

{
    "created_epoch": "1412812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1104220722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "213-740-0215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1031 W 34TH ST STE 450",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900893603",
            "telephone_number": "213-740-0215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKKELSEN",
        "first_name": "PAMELA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-09",
        "last_updated": "2023-11-27",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "41726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pamela.mikkelsen@direct.usc.edu",
            "affiliation": "Y",
            "affiliationName": "USC CARE MEDICAL GROUP, INC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1031 W 34th St Ste 450",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900893603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.