Kenneth T Thompson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA22683 Issued in CA

Practice address

2780 Tapo Canyon Rd
Suite A3
Simi Valley, CA 93063-6840

Phone

(805) 520-2929

Fax

(805) 520-2948

NPI assigned

Jan 2, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Comprehensive Community Health Centers IncGroup PAC ID 9638082456, 47 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: kenneththompson@cchc.trimed.direct-ci.com

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.

• Comprehensive Community Health Centers Inc

  • Family Medicine Physician
  • Glendale, CA
  • NPI 1356362743
  Medicare reassignment Care Compare group
• Comprehensive Community Health Centers, Inc

  • Family Medicine Physician
  • Arleta, CA
  • NPI 1346951654
  NPD
• Comprehensive Community Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Sunland, CA
  • NPI 1972954071
  NPD
• Rosaasen Physical Medicine Inc.

  • Non-Pharmacy Dispensing Site
  • Simi Valley, CA
  • NPI 1033481668
  NPD (past)

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

{
    "created_epoch": "1357084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357084800000",
    "number": "1609112192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11586 CUMPSTON ST",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916012636",
            "telephone_number": "818-763-3124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2780 TAPO CANYON RD",
            "address_2": "SUITE A3",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930636840",
            "telephone_number": "805-520-2929",
            "fax_number": "805-520-2948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "KENNETH",
        "middle_name": "T",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-01-02",
        "last_updated": "2013-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA22683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmine Ally Thomas
• Kyle Jon Thomas
• Walter Thomas, MD
• Alyson Thompson, MS, LMFT
• Cean Thompson, D.D.S.
• Mark Thompson, PTA
• Thrifty Payless Inc
• Thrifty Payless Inc
• Connaitre Shante Tillman
• Saudia Sumaiyah Tillman

• Physician Assistant in Simi Valley, CA
• Providers in Simi Valley, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2013; 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.