Individual provider Active NPI

Mary Crystal Kasmajian

  • Physician Assistant
  • Alhambra, CA
National Provider Identifier
1760116123
Registry record updated May 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1000 S Fremont Ave BLDG a-11
Alhambra, CA 91803-8800
Phone
(626) 457-4240
NPI assigned
Jul 12, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 24, 2023

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 Primary

Addresses

Primary practice location

1000 S Fremont Ave BLDG a-11
Alhambra, CA 91803-8800

Mailing address

1000 S Fremont Ave BLDG A11
Alhambra, CA 91803-8800

Other practice location 1

17210 Mayall St
Northridge, CA 91325-1555
Phone (818) 933-1188

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
I20231206001684 CA Practitioner - Physician Assistant 7113376997 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Southern California Keck School of Medicine, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Glendale Adventist Emergency Physicians IncorporatedGroup PAC ID 1254563869, 26 clinicians

Practice addresses (Care Compare)

1509 Wilson Ter
Glendale, CA 91206-4007
Phone (818) 863-4000

Hospital & facility affiliations

  • Glendale Adventist Medical Center Hospital, Glendale, CA, CCN 050239

Merit-based Incentive Payment System (MIPS)

Final score
92.41 of 100Reported as group
Quality
79.31
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Matian Medical Corp Current Accepting new patients

Organizations & group practices 3

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 1

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": "1657584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684886400000",
    "number": "1760116123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 S FREMONT AVE BLDG A11",
            "city": "ALHAMBRA",
            "state": "CA",
            "postal_code": "918038800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S FREMONT AVE BLDG A-11",
            "city": "ALHAMBRA",
            "state": "CA",
            "postal_code": "918038800",
            "telephone_number": "626-457-4240"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17210 Mayall St",
            "address_purpose": "LOCATION",
            "city": "Northridge",
            "state": "CA",
            "postal_code": "913251555",
            "country_code": "US",
            "telephone_number": "818-933-1188",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KASMAJIAN",
        "first_name": "MARY",
        "middle_name": "CRYSTAL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-12",
        "last_updated": "2023-05-24",
        "certification_date": "2023-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alhambra, CA

Sources for this page

Verify at the official NPI Registry.