Kimen M Colgan, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3531 Issued in AZ

Practice address

575 Price St
Suite101
Pismo Beach, CA 93449-2553

Phone

(805) 481-3685

Fax

(805) 481-5245

NPI assigned

Apr 12, 2006

Last updated

Sep 19, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• PCR Oncology, Inc.

  dba PCR Oncology

  • Hematology & Oncology Physician
  • Arroyo Grande, CA
  • NPI 1891139317
  Medicare reassignment
• Arroyo Grande Surgical Institute, LLC

  • Ambulatory Surgical Clinic/Center
  • Arroyo Grande, CA
  • NPI 1659941151
  NPD (past)
• Thomas D. Ferro M.D. a Medical Corporation

  • Orthopaedic Surgery Physician
  • Arroyo Grande, CA
  • NPI 1295782373
  NPD (past)
• Arizona Community Surgeons PC

  • Surgery Physician
  • Tucson, AZ
  • NPI 1689616070
  NPD (past)
• University Orthopedic Specialists, PLLC

  • Orthopaedic Surgery Physician
  • Tucson, AZ
  • NPI 1710065867
  NPD (past)

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

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474243200000",
    "number": "1699739227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 PRICE ST",
            "address_2": "STE 101",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934492553",
            "telephone_number": "805-481-3685",
            "fax_number": "805-481-5245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 PRICE ST",
            "address_2": "SUITE101",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934492553",
            "telephone_number": "805-481-3685",
            "fax_number": "805-481-5245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLGAN",
        "first_name": "KIMEN",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-12",
        "last_updated": "2016-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WI",
            "license": "1366",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "3531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41929300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Coastal Surgical Specialists, Inc.
• Coastal Village Primary Care
• Coastal Village Primary Care, a Medical Group
• Coastal Village Primary, Inc
• Terrell Cohen, D.D.S.
• Byron N Collier, DPM
• Teresa Maria Cordeiro, ANP
• County of San Luis Obispo (Judkins Middle School)
• Daniel Cramer I, M.D.
• Joseph A. Cruz, MD

• Physician Assistant in Pismo Beach, CA
• Providers in Pismo Beach, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2016; 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.

Verify at the official NPI Registry.