Kristofer Abejuela
Individual provider Active NPI Physician Assistant · Diamond Bar, CA
NPI 1194122234 · NPPES record last updated Dec 22, 2023
Key facts
- NPI
- 1194122234
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 52120 (CA)
- Practice address
- 2158 Derringer LN
Diamond Bar, CA 91765-3333 - Phone
- (909) 861-3358
- NPI assigned
- Dec 3, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
Merit-based Incentive Payment System (MIPS)
- Final score
- 85.48 of 100
- Quality
- 80.12
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 71.46
Merit-based Incentive Payment System (MIPS)
- Final score
- 96.69 of 100
- Quality
- 90
- Improvement activities
- 40
- Cost
- 78.43
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 |
|---|---|---|---|---|
| I20151203003040 | CA | Practitioner - Physician Assistant | 6305146994 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52120 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| County of Riverside | Current |
Accepting new patients | |
| Cep America- California | Current |
Accepting new patients | |
| County of Riverside | Current |
Accepting new patients | |
| El Camino Health Medical Group | Past | Accepting new patients |
Locations
2755 Herndon Ave
Clovis, CA 93611
Phone (559) 323-4000
1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423
393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914
308 E San Jacinto Ave
Perris, CA 92570
Phone (951) 940-6700
10800 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2000
Interoperability endpoints
- kabejuela100842@direct.llu.edu
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 52120 | CA | Yes |
Addresses
Primary practice location
2158 Derringer LN
Diamond Bar, CA 91765-3333
Mailing address
2158 Derringer LN
Diamond Bar, CA 91765-3333
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) | Southern California Permanente Medical Group |
Other providers in Diamond Bar, CA
- A&J Rehab Inc
- Abans Inc
- Sam Abaza
- Abba Hospice Inc
- Raghad Abdo
- Aberdeen Care LLC Dba Diamond Bar Rcfe
- Ritz-Albert Ablaza
- Above All Autism Center
- Aadil Abowath
- Sakina Abowath
All providers in Diamond Bar, 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 Dec 22, 2023. 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.