Individual provider Active NPI

Richard Eric Krajewski, P.A.-C

  • Physician Assistant
  • Lancaster, CA
National Provider Identifier
1215049002
Registry record updated Nov 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA18275 Issued in CA
Practice address
43839 15TH St W
Lancaster, CA 93534-4756
Phone
(661) 945-5984
Fax
(661) 723-6446
NPI assigned
Aug 31, 2006
Last updated
Nov 18, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2021

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 PA18275 CA Primary

Addresses

Primary practice location

43839 15TH St W
Lancaster, CA 93534-4756

Mailing address

PO Box 7007
Lancaster, CA 93539-7007
Phone (661) 945-5984

Electronic endpoints 1

TypeEndpointUseAffiliation
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

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
I20060223000740 CA Practitioner - Physician Assistant 4486660719 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

Practice addresses (Care Compare)

4949 Market St
Ventura, CA 93003-7851
Phone (877) 608-0044

888 S Hill Rd
Ventura, CA 93003-8400
Phone (805) 477-6400

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18275CAMDMental Health Counselor
PA18275CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Oct 31, 2017 Accepting new patients
Lakeside Medical Associates, a Medical Group, Inc. Past Accepting new patients

Locations

13652 Cantara St
Panorama City, CA 91402
Phone (818) 375-2417

393 E Walnut St
Unit 3
Pasadena, CA 91188

888 S Hill Rd
Ventura, CA 93003
Phone (805) 477-6400

5601 De Soto Ave
Woodland Hls, CA 91367
Phone (818) 719-2000

Interoperability endpoints

  • Direct secure messaging: richard.krajewski.p1@direct.lakeside.nextgenshare.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1215049002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7007",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935397007",
            "telephone_number": "661-945-5984",
            "fax_number": "661-723-6446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43839 15TH ST W",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935344756",
            "telephone_number": "661-945-5984",
            "fax_number": "661-723-6446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRAJEWSKI",
        "first_name": "RICHARD",
        "middle_name": "ERIC",
        "name_prefix": "Mr.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA18275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5601 De Soto Ave",
            "city": "Woodland Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913676701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lancaster, CA

Sources for this page

Verify at the official NPI Registry.