Kelly Lynn Brooks, PA-C
Individual provider Active NPI Surgical Physician Assistant · Fillmore, CA
NPI 1366689358 · NPPES record last updated Dec 3, 2021
Key facts
- NPI
- 1366689358
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- License
- 20091 (CA)
- Practice address
- 828 W Ventura St Ste 100
Fillmore, CA 93015-1877 - Phone
- (805) 524-2000
- NPI assigned
- Jan 13, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southern California Permanente Medical Group
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
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091013000348 | CA | Practitioner - Physician Assistant | 6002952694 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20091 | CA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| County of Ventura | Past |
Accepting new patients |
Locations
393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914
888 S Hill Rd
Ventura, CA 93003
Phone (805) 477-6400
5601 De Soto Ave
Woodland Hls, CA 91367
Phone (818) 719-2000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 20091 | CA | Yes |
Addresses
Primary practice location
828 W Ventura St Ste 100
Fillmore, CA 93015-1877
Mailing address
4484 Coffeetree LN
Moorpark, CA 93021-3533
Phone (805) 529-2225
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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 |
Other providers in Fillmore, CA
- Jorge O Bautista
- Boma Corp
- Candice Marie Bowen
- Anita Nanda Brahme
- Amelia J Breckenridge
- Michelle Denise Brown
- Logan K. Bundy
- Stephanie L Cadman
- Lidia R Calderon
- Jesus Cardenas
All providers in Fillmore, CA · Surgical Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.