Debra Lynn Gromacki-Blyth, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA10615 Issued in CA

Practice address

31720 Temecula Pkwy
Suite 203
Temecula, CA 92592-5802

Phone

(951) 303-6900

Fax

(951) 303-2900

NPI assigned

Aug 25, 2008

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

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1219622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369094400000",
    "number": "1124275847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31720 TEMECULA PKWY",
            "address_2": "SUITE 203",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925925802",
            "telephone_number": "951-303-6900",
            "fax_number": "951-303-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31720 TEMECULA PKWY",
            "address_2": "SUITE 203",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925925802",
            "telephone_number": "951-303-6900",
            "fax_number": "951-303-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROMACKI-BLYTH",
        "first_name": "DEBRA",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-25",
        "last_updated": "2013-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA10615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Temecula, CA
• Providers in Temecula, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.