Jafari Kinte Brown, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA20020 Issued in CA

Practice address

26520 Cactus Ave
Moreno Valley, CA 92555-3927

Phone

(951) 486-5960

NPI assigned

Jan 18, 2010

Last updated

Dec 1, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

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

Specialty

Physician Assistant

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern California Permanente Medical GroupGroup PAC ID 6002729175, shared by 4 NPIs, 11,250 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Riverside, CA
  • NPI 1316979834
  Medicare reassignment
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280
  Medicare reassignment
• Southern California Permanente Medical Group

  dba Target Clinic Medical Associates of Southern California

  • Health Maintenance Organization
  • Fullerton, CA
  • NPI 1336556059
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Fontana, CA
  • NPI 1689606196
  NPD

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

{
    "created_epoch": "1263772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1427389238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16915 LAKE KNOLL PKWY",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925036561",
            "telephone_number": "951-809-2818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26520 CACTUS AVE",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925553927",
            "telephone_number": "951-486-5960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "JAFARI",
        "middle_name": "KINTE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-01-18",
        "last_updated": "2021-12-01",
        "certification_date": "2020-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA20020",
            "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": []
}

• Edith Broughton, RN
• Alexis Rose Brown
• Bryan Brown
• Carol Theresa Brown
• Cherylann Brown
• Toinete Brown
• Michael Brummer
• Cassandra Bryant
• Darrius Buenaventura, DO
• Carl Buford

• Surgical Physician Assistant in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Surgical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; 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.