Scott Cummings Baron, P.A
Individual provider Active NPI Physician Assistant · Lake Forest, CA
NPI 1104861384 · NPPES record last updated Jan 10, 2008
Key facts
- NPI
- 1104861384
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA12400 (CA)
- Practice address
- 22855 Lake Forest Dr Ste a
Lake Forest, CA 92630-1656 - Phone
- (949) 452-7544
- NPI assigned
- Jun 19, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
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 |
|---|---|---|---|---|
| I20040929000880 | CA | Practitioner - Physician Assistant | 9335118041 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12400 | CA | MD | General Practice Physician |
| PA12400 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cep America - Auc, PC | Current |
Accepting new patients | |
| Cep America - Auc PC | Current |
Accepting new patients |
Locations
22855 Lake Forest Dr
Ste A
Lake Forest, CA 92630
Phone (949) 452-7544
23962 Alicia Pkwy
Ste I1
Mission Viejo, CA 92691
Phone (949) 297-0238
26137 La Paz Rd
Ste 120
Mission Viejo, CA 92691
Phone (949) 452-3309
1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA12400 | CA | Yes |
Addresses
Primary practice location
22855 Lake Forest Dr Ste a
Lake Forest, CA 92630-1656
Mailing address
2100 Powell St
Ste 920
Emeryville, CA 94608-1826
Phone (510) 350-2777
Other providers in Lake Forest, CA
- Chase Ballou Ballou
- Baran & Costa LLC
- Mahsa Barkhi
- Carol Ann Barnes-Blanks
- Braulio Antonio Baron
- Barouir Deirmenjian Dental Corporation
- Guadalupe Barrera
- Stephen W Barsamian
- Lyra Barton
- Zakia Sadaat Bashir
All providers in Lake Forest, 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 Jan 10, 2008. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.