Individual provider Active NPI

Kaitlyn Nicole Crouch, PA-C

  • Physician Assistant
  • Sacramento, CA
National Provider Identifier
1194316612
Registry record updated Jul 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
58624 Issued in CA
Practice address
1401 21St St Ste R
Sacramento, CA 95811-5226
Phone
(559) 439-7633
Fax
(559) 260-1131
NPI assigned
Jan 27, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 58624 CA Primary

Addresses

Primary practice location

1401 21St St Ste R
Sacramento, CA 95811-5226

Mailing address

1401 21St St Ste R
Sacramento, CA 95811-5226
Phone (209) 260-1131

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20210218001250 CA Practitioner - Physician Assistant 6204241565 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Foundation Medical GroupGroup PAC ID 0345406294, 282 clinicians

Practice addresses (Care Compare)

2335 E Kashian LN
Fresno, CA 93701-2234

7060 N Recreation Ave
Fresno, CA 93720-8022

Hospital & facility affiliations

  • Clovis Community Medical Center Hospital, Clovis, CA, CCN 050492

Merit-based Incentive Payment System (MIPS)

Final score
90.41 of 100Reported as group
Quality
87.02
Promoting interoperability
100
Improvement activities
40
Cost
78.21

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
58624CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Foundation Medical Group CurrentSince Jan 26, 2021 Accepting new patients
Community Foundation Medical Group Past Accepting new patients

Locations

729 N Medical Center Dr W
Ste 101
Clovis, CA 93611
Phone (559) 439-7631

7370 N Palm Ave
Ste 101
Fresno, CA 93711
Phone (559) 228-4222

2335 E Kashian Ln
Ste 270
Fresno, CA 93701
Phone (559) 445-1251

7095 N Chestnut Ave
Ste 102
Fresno, CA 93720
Phone (559) 321-2930

7050 N Recreation Ave
Ste 105
Fresno, CA 93720
Phone (559) 321-2930

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1611705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784678400000",
    "number": "1194316612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 21ST ST STE R",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958115226",
            "telephone_number": "209-260-1131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 21ST ST STE R",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958115226",
            "telephone_number": "559-439-7633",
            "fax_number": "559-260-1131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROUCH",
        "first_name": "KAITLYN",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-27",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "58624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.