Cheryl Ketelsen

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

53363 Issued in CA

Practice address

15 Santa Rosa St
San Luis Obispo, CA 93405-1811

Phone

(805) 541-2650

Fax

(805) 541-4043

NPI assigned

Apr 29, 2016

Sex

Female

Sole proprietor

Yes

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

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

San Luis Dermatology, Inc.Group PAC ID 5496700767, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• French Hospital Medical Center Hospital, San Luis Obispo, CA, CCN 050232
• Marian Regional Medical Center Hospital, Santa Maria, CA, CCN 050107

Merit-based Incentive Payment System (MIPS)

Final score

86.58 of 100Reported as group

Quality

96.73

Improvement activities

40

Cost

59.63

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 and National Provider Directory roles.

• San Luis Dermatology, Inc.

  • Dermatology Physician
  • San Luis Obispo, CA
  • NPI 1568431500
  Medicare reassignment Care Compare group
• R Jeffrey Herten MD Inc

  • Dermatology Physician
  • San Luis Obispo, CA
  • NPI 1730279944
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Dignity Community Care

  • General Acute Care Hospital
  • San Luis Obispo, CA
  • NPI 1881760452
  Care Compare affiliation
• Dignity Health

  • General Acute Care Hospital
  • Santa Maria, CA
  • NPI 1760510937
  Care Compare affiliation

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

{
    "created_epoch": "1461888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492646400000",
    "number": "1770938532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 SANTA ROSA ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934051811",
            "telephone_number": "805-541-2650",
            "fax_number": "805-541-4043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 SANTA ROSA ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934051811",
            "telephone_number": "805-541-2650",
            "fax_number": "805-541-4043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETELSEN",
        "first_name": "CHERYL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-29",
        "last_updated": "2017-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "53363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth P. Tway, M.D., F.a.C.C., Inc.
• Dara Lynn Kerkorian, MSW
• Valerie Ann Marie Kert
• Grace Elisabeth Kessler I
• Penny Ketchum
• Kevin Parzych a Medical Corp
• John A Khan-Variba, MD
• Elham Khodabandeloo, L.AC.
• Kallie Elizabeth Kidder
• Lani Kidman

• Medical Physician Assistant in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.