Darryl Lamont Davenport, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

54451 Issued in CA

Practice address

200 Mercy CR
Camp Pendlton, CA 92055

Phone

(951) 308-2200

NPI assigned

Jul 23, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: darryldavenport@vucdbaiuc.allscriptsdirect.net

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.

• Em Alliance California, Apc

  • Emergency Medicine Physician
  • Murrieta, CA
  • NPI 1376305755
  Medicare reassignment
• Inland Urgent Care a Medical Corporation

  • Urgent Care Clinic/Center
  • Corona, CA
  • NPI 1013369321
  NPD
• Vitality Urgent Care a Medical Corporation

  • Urgent Care Clinic/Center
  • Temecula, CA
  • NPI 1649052218
  NPD

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

{
    "created_epoch": "1216771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741651200000",
    "number": "1396900965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3406A DALY ST",
            "city": "TWENTYNINE PALMS",
            "state": "CA",
            "postal_code": "922779467",
            "telephone_number": "760-830-6065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MERCY CR",
            "city": "CAMP PENDLTON",
            "state": "CA",
            "postal_code": "92055",
            "telephone_number": "951-308-2200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Brewster Blvd",
            "address_2": "ATTN II MEF MHG GAS",
            "address_purpose": "LOCATION",
            "city": "Camp Lejeune",
            "state": "NC",
            "postal_code": "285472538",
            "country_code": "US",
            "telephone_number": "910-451-2635",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "27168 Newport Rd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Menifee",
            "state": "CA",
            "postal_code": "925847383",
            "country_code": "US",
            "telephone_number": "951-246-3033",
            "fax_number": "951-246-7373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "DARRYL",
        "middle_name": "LAMONT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-23",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "54451",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "54451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.