Individual provider Active NPI

Heidi Krystal Kendeigh, PA

  • Physician Assistant
  • Apple Valley, CA
National Provider Identifier
1699436600
Registry record updated Jan 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
18300 Ca-18
Apple Valley, CA 92307
Phone
(760) 242-2311
NPI assigned
Jan 3, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2022

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 CA Primary

Addresses

Primary practice location

18300 Ca-18
Apple Valley, CA 92307

Mailing address

303 Cardinal LN
Upland, CA 91786-7723
Phone (630) 205-1443

Other names 1

  • Heidi Krystal Gaenzle Former name

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
I20220331002592 CA Practitioner - Physician Assistant 6305232281 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
96.69 of 100Reported as group
Quality
90
Improvement activities
40
Cost
78.43

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
60672CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California CurrentSince Mar 1, 2022 Accepting new patients

Locations

18300 US Highway 18
Apple Valley, CA 92307
Phone (760) 424-2311

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1641168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1699436600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 CARDINAL LN",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917867723",
            "telephone_number": "630-205-1443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18300 CA-18",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "92307",
            "telephone_number": "760-242-2311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENDEIGH",
        "first_name": "HEIDI",
        "middle_name": "KRYSTAL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-03",
        "last_updated": "2022-01-03",
        "certification_date": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEIDI",
            "last_name": "GAENZLE",
            "middle_name": "KRYSTAL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Apple Valley, CA

Sources for this page

Verify at the official NPI Registry.