Individual provider Active NPI

Kimberly Dawn Kasperek, P.A.

  • Physician Assistant
  • Long Beach, CA
National Provider Identifier
1679905822
Registry record updated Nov 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA23111 Issued in CA
Practice address
3711 Long Beach Blvd Ste 700
Long Beach, CA 90807-3353
Phone
(562) 424-8422
NPI assigned
Jul 30, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA23111 CA Primary

Addresses

Primary practice location

3711 Long Beach Blvd Ste 700
Long Beach, CA 90807-3353

Mailing address

3711 Long Beach Blvd Ste 700
Long Beach, CA 90807-3353
Phone (562) 424-8422

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20150203000988 CA Practitioner - Physician Assistant 3971828534 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northbay Physicians Surgery Center, LLCGroup PAC ID 0042122244, 336 clinicians
Northbay Health Medical FoundationGroup PAC ID 3274010871, 207 clinicians

Practice addresses (Care Compare)

1200 B Gale Wilson Blvd
Fairfield, CA 94533-3552
Phone (707) 429-3600

1305 Stratford Ave
Dixon, CA 95620-2024
Phone (707) 646-5500

416 Napa Junction Rd
American Canyon, CA 94503-1281
Phone (707) 646-5500

Hospital & facility affiliations

  • Providence Queen of the Valley Medical Center Hospital, Napa, CA, CCN 050009

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA23111CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northbay Health Medical Foundation CurrentSince Jan 1, 2026 Accepting new patients
Southern California Permanente Medical Group CurrentSince Oct 14, 2017 Accepting new patients
Northbay Healthcare Group CurrentSince Mar 1, 2024 Accepting new patients
Northbay Healthcare Group CurrentSince Mar 1, 2024 Accepting new patients
Southern California Permanente Medical Group CurrentSince Oct 14, 2017 Accepting new patients

Locations

416 Napa Junction Rd
Ste 140
American Canyon, CA 94503

1305 Stratford Ave
Dixon, CA 95620

1200 B Gale Wilson Blvd
Fairfield, CA 94533
Phone (707) 429-3600

1000 Trancas St
Napa, CA 94558
Phone (707) 226-2901

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

1010 Nut Tree Rd
Ste 100B
Vacaville, CA 95687
Phone (707) 646-7999

1679 E Monte Vista Ave
Ste 104
Vacaville, CA 95688
Phone (707) 624-7400

888 S Hill Rd
Ventura, CA 93003
Phone (805) 477-6400

101 Main St
Winters, CA 95694
Phone (530) 795-4123

5601 De Soto Ave
Woodland Hls, CA 91367
Phone (818) 719-2000

Organizations & group practices 9

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1375142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1679905822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3711 LONG BEACH BLVD STE 700",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908073353",
            "telephone_number": "562-424-8422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3711 LONG BEACH BLVD STE 700",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908073353",
            "telephone_number": "562-424-8422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASPEREK",
        "first_name": "KIMBERLY",
        "middle_name": "DAWN",
        "name_prefix": "Ms.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-30",
        "last_updated": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA23111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5601 De Soto Ave",
            "city": "Woodland Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913676701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.