Elyssa Summer McCormack, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA58537 Issued in CA

Practice address

101 E Valencia Mesa Dr
Fullerton, CA 92835-3809

Phone

(714) 626-8500

NPI assigned

Sep 19, 2020

Last updated

Jan 26, 2022By 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 1

Addresses

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

State licenses

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.

• Fountain Valley Emergency Physicians, P.C.

  • Emergency Medicine Physician
  • Fountain Valley, CA
  • NPI 1639698475
  Medicare reassignment
• Michael S. Agron, M.D., Inc.

  • Emergency Medicine Physician
  • Arcadia, CA
  • NPI 1699716100
  Medicare reassignment
• St Jude Emergency Medical Group Inc

  • Emergency Medicine Physician
  • Fullerton, CA
  • NPI 1720190804
  Medicare reassignment

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

{
    "created_epoch": "1600473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1710593397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E VALENCIA MESA DR",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353809",
            "telephone_number": "714-626-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E VALENCIA MESA DR",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353809",
            "telephone_number": "714-626-8500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 W Huntington Dr",
            "address_purpose": "LOCATION",
            "city": "Arcadia",
            "state": "CA",
            "postal_code": "910073402",
            "country_code": "US",
            "telephone_number": "626-898-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCORMACK",
        "first_name": "ELYSSA",
        "middle_name": "SUMMER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-19",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA58537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marcelene McClendon
• Shawnte N McClendon
• Joanne McCluskey, LCSW
• Lashawn Renee McCombs, NP
• Michael P. McConnell, MD
• Krystal Alexis McCoy
• Nikole Donelon McCoy, BCBA
• Robert Emmitt McCoy, M.D.
• William McCoy
• Ellie Kristine McCready

• Physician Assistant in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 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.

Verify at the official NPI Registry.