Carrie R. K. Brothers, PA-C
Individual provider Active NPI Physician Assistant · Arcata, CA
NPI 1104368331 · NPPES record last updated Nov 8, 2024
Key facts
- NPI
- 1104368331
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 53861 (CA)
- Practice address
- 1150 Foster Ave
Arcata, CA 95521-5986 - Phone
- (805) 682-8844
- NPI assigned
- Nov 4, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 13
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Open Door Community Health Centers
Practice addresses (Care Compare)
1150 Foster Ave
Arcata, CA 95521-5986
Phone (707) 826-8610
2200 Tydd St
Eureka, CA 95501-1284
Phone (707) 441-1624
770 10TH St
Arcata, CA 95521-6210
Phone (707) 826-8610
Hospital & facility affiliations
- Mad River Community Hospital
- Providence St Joseph Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170626001079 | CA | Practitioner - Physician Assistant | 5496023962 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53861 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Open Door Community Health Centers | Current | Accepting new patients | |
| Open Door Community Health Centers | Current |
Accepting new patients | |
| Open Door Community Health Centers | Current |
Accepting new patients | |
| Open Door Community Health Centers | Current | Accepting new patients | |
| Open Door Community Health Centers | Current | Accepting new patients | |
| Open Door Community Health Centers | Current | Accepting new patients | |
| Sansum Clinic | Past | Accepting new patients |
Locations
1150 Foster Ave
Arcata, CA 95521
Phone (707) 822-2481
785 18th St
Arcata, CA 95521
Phone (707) 822-2481
1275 8th St
Arcata, CA 95521
770 10th St
Arcata, CA 95521
Phone (707) 826-8610
550 E Washington Blvd
Crescent City, CA 95531
Phone (707) 465-4636
2200 Tydd St
Eureka, CA 95501
Phone (707) 269-7051
1644 Central Ave
McKinleyville, CA 95519
Phone (707) 839-3068
Interoperability endpoints
- cbrothers170979@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 53861 | CA | Yes |
Addresses
Primary practice location
1150 Foster Ave
Arcata, CA 95521-5986
Mailing address
805 Westmont Rd
Santa Barbara, CA 93108-1032
Other providers in Arcata, CA
- Jenoa Briar-Bonpane
- Kevin L Brink
- Jonathan Peter Broadhurst
- Dayna L Brockman
- Amy P. Brom
- Adam Brown
- Bridget Brown
- Chad Brown
- Jennifer Valerie Brown
- Travis Brown
All providers in Arcata, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.