Individual provider Active NPI

Kelli Nowak, PA-C

  • Physician Assistant
  • Palm Springs, CA
National Provider Identifier
1255760443
Registry record updated Mar 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
53120 Issued in CA
Practice address
1100 N Palm Canyon Dr Ste 212
Palm Springs, CA 92262-4426
Phone
(760) 327-7900
Fax
(760) 327-7905
NPI assigned
Nov 7, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 53120 CA Primary
Physician Assistant 363A00000X 085004934 IL

Addresses

Primary practice location

1100 N Palm Canyon Dr Ste 212
Palm Springs, CA 92262-4426

Mailing address

1100 N Palm Canyon Dr Ste 212
Palm Springs, CA 92262-4426
Phone (760) 327-7900

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
I20200327002168 CA Practitioner - Physician Assistant 8820422140 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1865 E Alluvial Ave
Suite 102
Fresno, CA 93720-3855
Phone (559) 981-2600

2335 E Kashian LN
Fresno, CA 93701-2234

Hospital & facility affiliations

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

State licenses

LicenseStateTypeSpecialty
085004934ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Community Foundation Medical Group CurrentSince Aug 24, 2020 Accepting new patients
Advanced Women'S Healthcare, a Medical Corporation Past Accepting new patients

Locations

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

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 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": "1383782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553472000000",
    "number": "1255760443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 N PALM CANYON DR STE 212",
            "city": "PALM SPRINGS",
            "state": "CA",
            "postal_code": "922624426",
            "telephone_number": "760-327-7900",
            "fax_number": "760-327-7905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N PALM CANYON DR STE 212",
            "city": "PALM SPRINGS",
            "state": "CA",
            "postal_code": "922624426",
            "telephone_number": "760-327-7900",
            "fax_number": "760-327-7905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOWAK",
        "first_name": "KELLI",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-07",
        "last_updated": "2019-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "53120",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085004934",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Springs, CA

Sources for this page

Verify at the official NPI Registry.