NPIMap

Individual provider Active NPI

Kristine Supple, PA

  • Physician Assistant
  • Oxnard, CA
National Provider Identifier
1720157233
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
15019 Issued in CA
Practice address
2921 Saviers Rd
Oxnard, CA 93033-5314
Phone
(805) 487-5588
Fax
(805) 487-5589
NPI assigned
Nov 7, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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 15019 CA Primary

Addresses

Primary practice location

2921 Saviers Rd
Oxnard, CA 93033-5314

Mailing address

2705 Loma Vista Rd
Suite 205
Ventura, CA 93003-1581
Phone (805) 667-2801

Other identifiers 5

IdentifierTypeStateIssuer
RHM08608FMedicaidCA
RHM18553HMedicaidCA
RHM08609FMedicaidCA
ZZT40394FMedicaidCA
95-1683892OtherCAOTHER INSURANCE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060209000706 CA Practitioner - Physician Assistant 0749295806 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Memorial Health System 187 clinicians

Practice addresses (Care Compare)

147 N Brent St
Ventura, CA 93003-2809
Phone (805) 652-5011

422 Arneill Rd B
Camarillo, CA 93010-6434
Phone (805) 383-4510

5800 Santa Rosa Rd
Suite 149
Camarillo, CA 93012-7061
Phone (805) 667-2801

Hospital & facility affiliations

  • Community Memorial Hospital - Ventura Hospital, Ventura, CA, CCN 050394

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15019CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Memorial Health System CurrentSince Dec 12, 2005 Accepting new patients
Community Memorial Health System CurrentSince Dec 12, 2005 Accepting new patients
Community Memorial Health System Past Accepting new patients

Locations

422 Arneill Rd
Ste B
Camarillo, CA 93010
Phone (805) 383-4510

852 W Ventura St
Fillmore, CA 93015
Phone (805) 524-2672

2921 Saviers Rd
Oxnard, CA 93033
Phone (805) 487-5588

250 Citrus Grove Ln
Ste 150
Oxnard, CA 93036
Phone (805) 981-3770

138 W Main St
Ste E
Ventura, CA 93001
Phone (805) 667-2850

147 N Brent St
Ventura, CA 93003
Phone (805) 652-5011

2705 Loma Vista Rd
Ste 205
Ventura, CA 93003
Phone (805) 585-3086

5855 Olivas Park Dr
Ventura, CA 93003
Phone (805) 652-5469

Interoperability endpoints

  • Direct secure messaging: ksupple3518466@oc.providencedirect.org
  • Direct secure messaging: kristinesupple@cfh.allscriptsdirect.net

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 10

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": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1720157233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2705 LOMA VISTA RD",
            "address_2": "SUITE 205",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930031581",
            "telephone_number": "805-667-2801",
            "fax_number": "805-641-1706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2921 SAVIERS RD",
            "city": "OXNARD",
            "state": "CA",
            "postal_code": "930335314",
            "telephone_number": "805-487-5588",
            "fax_number": "805-487-5589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPPLE",
        "first_name": "KRISTINE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-07",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "15019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM08608F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM18553H",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM08609F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT40394F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER INSURANCE",
            "identifier": "95-1683892",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oxnard, CA

Sources for this page

Verify at the official NPI Registry.