Individual provider Active NPI

Philomina Eyong, PA

  • Medical Physician Assistant
  • Santa Monica, CA
National Provider Identifier
1164560264
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA 13728 Issued in AL
Practice address
1711 Ocean Park Blvd
Santa Monica, CA 90405-4901
Phone
(310) 450-2191
Fax
(310) 450-0873
NPI assigned
Feb 1, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA 13728 AL Primary

Addresses

Primary practice location

1711 Ocean Park Blvd
Santa Monica, CA 90405-4901

Mailing address

7 Pepperwood Cir
Pomona, CA 91766-4742
Phone (909) 622-7933

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
13728CAMDOptometrist
PA 13728ALMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Westside Family Health Center Past Accepting new patients
Westside Family Health Center Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JAHCCA

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.

NPI Registry JSON

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164560264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 PEPPERWOOD CIR",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917664742",
            "telephone_number": "909-622-7933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 OCEAN PARK BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904054901",
            "telephone_number": "310-450-2191",
            "fax_number": "310-450-0873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EYONG",
        "first_name": "PHILOMINA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AL",
            "license": "PA 13728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.