Kevin William Canedy, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

91275 66TH Avenue
Suite 500
Mecca, CA 92254

Phone

(760) 396-1249

NPI assigned

Sep 12, 2021

Last updated

Oct 7, 2026By the provider in NPPES

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, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Indio Emergency Medical Group Inc

  dba Desert Urgent Care

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Palm Desert, CA
  • NPI 1376766808
  Medicare reassignment NPD
• Coachella Valley Care Medical Associates Inc

  • Family Medicine Physician
  • Indio, CA
  • NPI 1811319890
  Medicare reassignment

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

{
    "created_epoch": "1631404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791331200000",
    "number": "1609545656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91275 66TH AVENUE",
            "address_2": "SUITE 500",
            "city": "MECCA",
            "state": "CA",
            "postal_code": "92254",
            "telephone_number": "760-396-1249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91275 66TH AVENUE",
            "address_2": "SUITE 500",
            "city": "MECCA",
            "state": "CA",
            "postal_code": "92254",
            "telephone_number": "760-396-1249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANEDY",
        "first_name": "KEVIN",
        "middle_name": "WILLIAM",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-09-12",
        "last_updated": "2026-10-07",
        "certification_date": "2026-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edgar Ivan Aguilar
• Amis Pharmacy Corporation (Mecca Community Pharmacy)
• Jocelyn Avila-Bustos
• David Sea Jong Chang, MD
• Clinicas de Salud del Pueblo Inc (Innercare)
• Clinicas de Salud del Pueblo Inc (Innercare)
• Clinicas de Salud del Pueblo, Inc (Innercare)
• Clinicas de Salud del Pueblo, Inc (Innercare)

• Physician Assistant in Mecca, CA
• Providers in Mecca, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2026; 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.