Active NPI
Kimberly J. Erlich, RN CPNP
- Pediatric Nurse Practitioner
- San Mateo, CA
National Provider Identifier
1104852532
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 13675
- Practice address
- 100 S San Mateo Dr
3Rd Floor, RM 3364
San Mateo, CA 94401-3805 - Phone
- (650) 696-4595
- NPI assigned
- Jun 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 13675 | CA | Primary |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 13675 | CA |
Addresses
Primary practice location
100 S San Mateo Dr
3Rd Floor, RM 3364
San Mateo, CA 94401-3805
Mailing address
100 S San Mateo Dr
3Rd Floor, RM 3364
San Mateo, CA 94401-3805
Phone (650) 696-4595
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00136750 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Pediatric Nurse Practitioner, Nurse Practitioner, Registered Nurse
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Wellness Partners, a Professional Nursing Corporation | Pediatrics | Current | Accepting new patients |
| El Camino Health Medical Network, LLC | Past | Accepting new patients |
Interoperability endpoints
- lifestancehealth.kimberlyerlich@148377.advancedmd-direct.com
Organizations & group practices 2
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.
-
- Pediatric Nurse Practitioner
- Los Altos, CA
- NPI 1104684612
Pediatrics
-
- Multi-Specialty Clinic/Center
- San Jose, CA
- NPI 1164880761
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151193600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376438400000",
"number": "1104852532",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 S SAN MATEO DR",
"address_2": "3RD FLOOR, RM 3364",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944013805",
"telephone_number": "650-696-4595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 S SAN MATEO DR",
"address_2": "3RD FLOOR, RM 3364",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944013805",
"telephone_number": "650-696-4595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERLICH",
"first_name": "KIMBERLY",
"middle_name": "J.",
"name_prefix": "Ms.",
"credential": "RN CPNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-25",
"last_updated": "2013-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "CA",
"license": "13675",
"primary": true
},
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "CA",
"license": "13675",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00136750",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.