Active NPI
Kerry A Homotoff
- Physician Assistant
- Red Bluff, CA
National Provider Identifier
1639402399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA20521
- Practice address
- 2450 Sister Mary Columba Dr
Red Bluff, CA 96080-4356 - Phone
- (530) 527-0414
- Fax
- (530) 528-7923
- NPI assigned
- Sep 14, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA20521 | CA | Primary |
Addresses
Primary practice location
2450 Sister Mary Columba Dr
Red Bluff, CA 96080-4356
Mailing address
2450 Sister Mary Columba Dr
Red Bluff, CA 96080-4356
Phone (530) 527-0414
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20521 | CA | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Front Line Emergency Care Spec | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emergency Medicine Physician
- Lynwood, CA
- NPI 1366451080
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252886400000",
"number": "1639402399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2450 SISTER MARY COLUMBA DR",
"city": "RED BLUFF",
"state": "CA",
"postal_code": "960804356",
"telephone_number": "530-527-0414",
"fax_number": "530-528-7923"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2450 SISTER MARY COLUMBA DR",
"city": "RED BLUFF",
"state": "CA",
"postal_code": "960804356",
"telephone_number": "530-527-0414",
"fax_number": "530-528-7923"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOMOTOFF",
"first_name": "KERRY",
"middle_name": "A",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-14",
"last_updated": "2009-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA20521",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Red Bluff, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.