NPIMap

Individual provider Active NPI

Michael Fornoles Mendoza, PA-C

  • Physician Assistant
  • Mission Hills, CA
National Provider Identifier
1720209661
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA18750 Issued in CA
Practice address
15031 Rinaldi St
Mission Hills, CA 91345-1207
Phone
(818) 365-8051
NPI assigned
May 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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 PA18750 CA Primary

Addresses

Primary practice location

15031 Rinaldi St
Mission Hills, CA 91345-1207

Mailing address

20811 Tulsa St
Chatsworth, CA 91311-1535
Phone (818) 427-2141

Other identifiers 1

IdentifierTypeStateIssuer
PA18750MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20071024000377 CA Practitioner - Physician Assistant 0840387742 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

13652 Cantara St
Panorama City, CA 91402-5423
Phone (818) 375-2000

Hospital & facility affiliations

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
18750CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California CurrentSince Jun 5, 2015 Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 1, 1985 Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 1, 1985 Accepting new patients
New Hope Podiatry Group Inc. PastSince Dec 29, 2024 Accepting new patients

Locations

13652 Cantara St
Panorama City, CA 91402
Phone (818) 375-2417

888 S Hill Rd
Ventura, CA 93003
Phone (805) 477-6400

5601 De Soto Ave
Woodland Hls, CA 91367
Phone (818) 719-2000

Organizations & group practices 8

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 2

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": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1720209661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20811 TULSA ST",
            "city": "CHATSWORTH",
            "state": "CA",
            "postal_code": "913111535",
            "telephone_number": "818-427-2141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15031 RINALDI ST",
            "city": "MISSION HILLS",
            "state": "CA",
            "postal_code": "913451207",
            "telephone_number": "818-365-8051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "MICHAEL",
        "middle_name": "FORNOLES",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA18750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA18750",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "13652 Cantara St",
            "city": "Panorama City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "914025423",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mission Hills, CA

Sources for this page

Verify at the official NPI Registry.