Individual provider Active NPI

Kirsten Quitno Juliet, M.D.

  • Pediatrics Physician
  • Ukiah, CA
National Provider Identifier
1477538700
Registry record updated Jan 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A67729 Issued in CA
Practice address
260 Hospital Dr
Ukiah, CA 95482-4533
Phone
(707) 463-8000
Fax
(707) 462-1111
NPI assigned
Dec 9, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A67729 CA Primary

Addresses

Primary practice location

260 Hospital Dr
Ukiah, CA 95482-4533

Mailing address

PO Box 2739
Ukiah, CA 95482-2739
Phone (707) 463-8000

Other identifiers 1

IdentifierTypeStateIssuer
00A677290MedicaidCA

Other names 1

  • Kirsten Quitno Whelan Former name

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110504000151 CA Practitioner - Pediatric Medicine 2769667963 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A67729CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mendocino Community Health Clinic, Inc. Current Accepting new patients
Mendocino Community Health Clinic, Inc. CurrentSince Apr 8, 2024 Accepting new patients
Mendocino Community Health Clinic, Inc. Past Accepting new patients
Ukiah Adventist Hospital Past Accepting new patients

Locations

5335 Lakeshore Blvd
#H
Lakeport, CA 95453

333 Laws Ave
Ukiah, CA 95482
Phone (707) 463-1113

Interoperability endpoints

  • Direct secure messaging: kjuliet356455@direct.ochin.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1134086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390262400000",
    "number": "1477538700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2739",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954822739",
            "telephone_number": "707-463-8000",
            "fax_number": "707-462-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 HOSPITAL DR",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824533",
            "telephone_number": "707-463-8000",
            "fax_number": "707-462-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JULIET",
        "first_name": "KIRSTEN",
        "middle_name": "QUITNO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-09",
        "last_updated": "2014-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A67729",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A677290",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIRSTEN",
            "last_name": "WHELAN",
            "middle_name": "QUITNO",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ukiah, CA

Sources for this page

Verify at the official NPI Registry.