Kidney Care Services of Humboldt

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

23313 Issued in CA

Legal business name

KIDNEY CARE SERVICES OF HUMBOLDT

Practice address

1651 Myrtle Ave Ste C
Eureka, CA 95501-1495

Phone

(707) 599-6700

Fax

(888) 475-8698

NPI assigned

Jul 4, 2015

Organization subpart

No

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

Authorized official

Name

James Lee Wynn Jr.

Title

Admin Aide

Phone

(707) 599-6700

Specialties & licenses 4

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Interoperability endpoints

• Direct secure messaging: angela.smith.1@15882.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/15882/brand/1/csg/1/fhir/r4

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Angela Beth Smith, CNP

  • Adult Health Nurse Practitioner
  • Eureka, CA
  • NPI 1023368453
  Medicare reassignment
• Allen Sebastian Mathew, MD

  • Nephrology Physician
  • Eureka, CA
  • NPI 1417053075
  NPD (past)

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

{
    "created_epoch": "1435968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780531200000",
    "number": "1457734741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1651 MYRTLE AVE STE C",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955011495",
            "telephone_number": "707-599-6700",
            "fax_number": "888-475-8698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1651 MYRTLE AVE STE C",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955011495",
            "telephone_number": "707-599-6700",
            "fax_number": "888-475-8698"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2765 Timber Ridge Ln",
            "address_purpose": "LOCATION",
            "city": "Eureka",
            "state": "CA",
            "postal_code": "955034885",
            "country_code": "US",
            "telephone_number": "707-445-2033",
            "fax_number": "707-445-8026",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1550 Heartwood Dr",
            "address_purpose": "LOCATION",
            "city": "McKinleyville",
            "state": "CA",
            "postal_code": "955193984",
            "country_code": "US",
            "telephone_number": "707-839-4465",
            "fax_number": "707-839-4734",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KIDNEY CARE SERVICES OF HUMBOLDT",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-04",
        "last_updated": "2026-06-04",
        "certification_date": "2026-06-04",
        "status": "A",
        "authorized_official_last_name": "WYNN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "ADMIN AIDE",
        "authorized_official_telephone_number": "707-599-6700",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "23313",
            "primary": true
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RN846580",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "angela.smith.1@15882.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1651 Myrtle Ave Ste C",
            "city": "Eureka",
            "state": "CA",
            "country_code": "US",
            "postal_code": "955011495",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jamie Ann Keyes
• Shrawan Khadka, MD
• Steven Ling-Kok Khong, PHARMD
• Lucas D Kibbee
• Judy Sue Kidd
• Shamieka Kiel
• Laura Kiewel, PPSC
• Timm Kiewel
• Maureen Kiley, DDS
• Williiam B. Kilgore, M.D.

• Nephrology Physician in Eureka, CA
• Providers in Eureka, CA by specialty
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.