Active NPI
Kaitlyn Riley
- Physician Assistant
- Fairfield, CA
National Provider Identifier
1659945749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 2201 Courage Dr # Ms 9-100
Fairfield, CA 94533-6733 - Phone
- (707) 784-2010
- NPI assigned
- May 13, 2021
- Sex
- Female
- Sole proprietor
- No
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 | Primary |
Addresses
Primary practice location
2201 Courage Dr # Ms 9-100
Fairfield, CA 94533-6733
Mailing address
2201 Courage Dr # Ms 9-100
Fairfield, CA 94533-6733
Phone (707) 784-2010
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230116000428 | CA | Order and Referring Only - Physician Assistant | 8325419104 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61466 | CA | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Interoperability endpoints
- kriley716998@direct.ochin.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670716800000",
"number": "1659945749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2201 COURAGE DR # MS 9-100",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945336733",
"telephone_number": "707-784-2010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2201 COURAGE DR # MS 9-100",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945336733",
"telephone_number": "707-784-2010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RILEY",
"first_name": "KAITLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-13",
"last_updated": "2022-12-11",
"certification_date": "2022-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2022; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.