Individual provider Active NPI

Kelly Pataca

  • Family Nurse Practitioner
  • Fresno, CA
National Provider Identifier
1285235713
Registry record updated Nov 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95015791 Issued in CA
Practice address
6095 N 1St St
Fresno, CA 93710-5444
Phone
(559) 446-1515
NPI assigned
Nov 2, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95015791 CA Primary

Addresses

Primary practice location

6095 N 1St St
Fresno, CA 93710-5444

Mailing address

1691 The Alameda
San Jose, CA 95126-2203
Phone (408) 287-7526

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
I20201223000264 CA Practitioner - Nurse Practitioner 4688086283 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7050 N Recreation Ave
Suite 101
Fresno, CA 93720-8001
Phone (559) 325-3515

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
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Foundation Medical Group CurrentSince Oct 1, 2022 Accepting new patients
Community Foundation Medical Group Current Accepting new patients
Community Foundation Medical Group CurrentSince Oct 1, 2022 Accepting new patients

Locations

1374 E Alluvial Ave
Fresno, CA 93720
Phone (559) 450-7272

1865 E Alluvial Ave
Ste 102
Fresno, CA 93720
Phone (559) 435-6492

7050 N Recreation Ave
Ste 101
Fresno, CA 93720
Phone (559) 325-3515

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

7355 N Palm Ave
Ste 105
Fresno, CA 93711
Phone (559) 271-6300

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": "1604275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604275200000",
    "number": "1285235713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1691 THE ALAMEDA",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951262203",
            "telephone_number": "408-287-7526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6095 N 1ST ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937105444",
            "telephone_number": "559-446-1515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATACA",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-02",
        "last_updated": "2020-11-02",
        "certification_date": "2020-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95015791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.