Individual provider Active NPI

Kathleen A Macmahon, NP

  • Family Nurse Practitioner
  • Nipomo, CA
National Provider Identifier
1518197995
Registry record updated May 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
22934 Issued in CA
Practice address
150 Tejas PL
Nipomo, CA 93444-9123
Phone
(805) 929-3211
Fax
(805) 929-6359
NPI assigned
Jul 21, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 558798 CA
Nurse Practitioner 363L00000X R- MN
Family Nurse Practitioner 363LF0000X 22934 CA Primary

Addresses

Primary practice location

150 Tejas PL
Nipomo, CA 93444-9123

Mailing address

150 Tejas PL
Nipomo, CA 93444-9123
Phone (805) 929-3211

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
I20131216001601 CA Practitioner - Nurse Practitioner 4981742285 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R-MNMDNurse Practitioner
558798CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Centers of the Central Coast Inc CurrentSince May 24, 2014 Accepting new patients
Community Health Centers of the Central Coast Inc Current Accepting new patients
Community Health Centers of the Central Coast Inc CurrentSince May 24, 2014 Accepting new patients
Community Health Centers of the Central Coast Inc Current Accepting new patients

Locations

1057 E Grand Ave
Arroyo Grande, CA 93420
Phone (805) 270-1700

150 Tejas Pl
Nipomo, CA 93444
Phone (805) 929-3254

2801 Santa Maria Way
Bldg A
Santa Maria, CA 93455
Phone (805) 938-9200

2050 S Blosser Rd
Santa Maria, CA 93458
Phone (805) 361-8014

325 Posada Ln
Templeton, CA 93465
Phone (805) 239-0644

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": "1248134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399593600000",
    "number": "1518197995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 TEJAS PL",
            "city": "NIPOMO",
            "state": "CA",
            "postal_code": "934449123",
            "telephone_number": "805-929-3211",
            "fax_number": "805-929-6359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 TEJAS PL",
            "city": "NIPOMO",
            "state": "CA",
            "postal_code": "934449123",
            "telephone_number": "805-929-3211",
            "fax_number": "805-929-6359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACMAHON",
        "first_name": "KATHLEEN",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-21",
        "last_updated": "2014-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "558798",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "R-",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "22934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nipomo, CA

Sources for this page

Verify at the official NPI Registry.