Individual provider Active NPI

Kelly Lewis, NP-C

  • Family Nurse Practitioner
  • Victorville, CA
National Provider Identifier
1427640150
Registry record updated Feb 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95016605 Issued in CA
Practice address
16850 Bear Valley Rd
Victorville, CA 92395-5794
Phone
(760) 241-8000
NPI assigned
Feb 4, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2021

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 95016605 CA Primary

Addresses

Primary practice location

16850 Bear Valley Rd
Victorville, CA 92395-5794

Mailing address

16850 Bear Valley Rd
Victorville, CA 92395-5794
Phone (760) 241-8000

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
I20210726003315 CA Practitioner - Nurse Practitioner 3173926383 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
Desert Valley Medical Group IncGroup PAC ID 4880595875, 78 clinicians

Practice addresses (Care Compare)

12276 Hesperia Rd
Suite 2
Victorville, CA 92395-5838
Phone (760) 241-8000

16850 Bear Valley Rd
Victorville, CA 92395-5794
Phone (760) 241-8000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95120156CAMDCommunity Health Registered Nurse
95016605CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Desert Valley Medical Group, Inc CurrentSince Apr 14, 2021 Accepting new patients
Desert Valley Medical Group, Inc. CurrentSince Apr 14, 2021 Accepting new patients
Desert Valley Medical Group, Inc. Current Accepting new patients
Desert Valley Hospital, LLC Past Accepting new patients

Locations

12276 Hesperia Rd
Ste 2
Victorville, CA 92395

12276 Hesperia Rd
Ste C
Victorville, CA 92395
Phone 7602418000 ext. 5133

12276 Hesperia Rd
Victorville, CA 92395
Phone (760) 962-8007

16850 Bear Valley Rd
Ste 100
Victorville, CA 92395

16850 Bear Valley Rd
Victorville, CA 92395
Phone (760) 241-8222

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: kelly.lewisfnp.p1@direct.dvmg.nextgenshare.com

Organizations & group practices 4

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": "1612396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612396800000",
    "number": "1427640150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16850 BEAR VALLEY RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955794",
            "telephone_number": "760-241-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16850 BEAR VALLEY RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955794",
            "telephone_number": "760-241-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "KELLY",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-04",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95016605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.