NPIMap

Individual provider Active NPI

James Datson Herndon, PA-C

  • Physician Assistant
  • Rancho Mirage, CA
National Provider Identifier
1689924581
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA16694 Issued in CA
Practice address
69730 Highway 111 Ste 109
Rancho Mirage, CA 92270-2873
Phone
(760) 778-6120
Fax
(607) 406-6077
NPI assigned
Sep 18, 2012
Last updated
Oct 15, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA156961 OR
Physician Assistant 363A00000X PA16694 CA Primary

Addresses

Primary practice location

69730 Highway 111 Ste 109
Rancho Mirage, CA 92270-2873

Mailing address

69730 Highway 111 Ste 109
Rancho Mirage, CA 92270-2873
Phone (206) 852-8815

Other practice location 1

44359 Palm St
Indio, CA 92201-3116
Phone (760) 342-6616

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PA16694CAMDPhysician Assistant
PA156961ORMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
J.Herndons, LLC CurrentSince Jul 21, 2024 Accepting new patients
A.B.C. Recovery Center, Inc. Past Accepting new patients
A.B.C. Recovery Center, Inc. Past Accepting new patients

Locations

69730 Highway 111
Ste 109
Rancho Mirage, CA 92270
Phone (760) 322-1777

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1347926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1689924581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69730 HIGHWAY 111 STE 109",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922702873",
            "telephone_number": "206-852-8815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69730 HIGHWAY 111 STE 109",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922702873",
            "telephone_number": "760-778-6120",
            "fax_number": "607-406-6077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "44359 Palm St",
            "address_purpose": "LOCATION",
            "city": "Indio",
            "state": "CA",
            "postal_code": "922013116",
            "country_code": "US",
            "telephone_number": "760-342-6616",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERNDON",
        "first_name": "JAMES",
        "middle_name": "DATSON",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-09-18",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA156961",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA16694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Mirage, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.