Camille Renee Richardson

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA58675 Issued in CA

Practice address

309 E 2ND St
Pomona, CA 91766-1854

Phone

(909) 623-6116

NPI assigned

Jul 30, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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

Merit-based Incentive Payment System (MIPS)

Final score

96.69 of 100Reported as group

Quality

90

Improvement activities

40

Cost

78.43

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Cep America - California

  • Emergency Medicine Physician
  • Santa Ana, CA
  • NPI 1548667843
  Medicare reassignment
• West Coast Wound and Skin Care Inc

  • Surgery Physician
  • Burbank, CA
  • NPI 1437675980
  Medicare reassignment
• Cep America - California

  • Emergency Medicine Physician
  • Pomona, CA
  • NPI 1740235258
  NPD

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

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695686400000",
    "number": "1336758705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 N BASILIO AVE",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917732707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 E 2ND ST",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917661854",
            "telephone_number": "909-623-6116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "CAMILLE",
        "middle_name": "RENEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-30",
        "last_updated": "2023-09-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA58675",
            "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": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ricardo Di Sarli MD a Medical Corporation
• Ricardo Frank Jara Castro DDS, Inc.
• Kevin Rice, LCSW
• Richard J. Veirs Chiropractic P.C.
• Brittny D Richard
• Chanda Richardson
• Deirdre Leigh Richardson
• Sage Richardson
• Tyler J Richins
• Barth Bishop Riedel, MD

• Physician Assistant in Pomona, CA
• Providers in Pomona, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.