Individual provider Active NPI

Patrick John Coffey, PA-C

  • Physician Assistant
  • Victorville, CA
National Provider Identifier
1811399645
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
14011 Park Ave
Victorville, CA 92392-2413
Phone
(951) 788-3000
NPI assigned
Sep 24, 2014
Last updated
Oct 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

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 CA Primary

Addresses

Primary practice location

14011 Park Ave
Victorville, CA 92392-2413

Mailing address

16840 Canyon View Dr
Riverside, CA 92504-6252
Phone (951) 733-9979

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: 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
I20150204002381 CA Practitioner - Physician Assistant 2961428883 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

14011 Park Ave
Victorville, CA 92392-2413
Phone (888) 750-0036

9961 Sierra Ave
Fontana, CA 92335-6720
Phone (909) 427-5000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
52033CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Emergency Medicine CurrentSince Dec 31, 2016 Accepting new patients
Southern California Permanente Medical Group CurrentSince Sep 2, 2017 Accepting new patients
Cep America - California CurrentSince Nov 15, 2014 Accepting new patients
Southern California Emergency Medicine CurrentSince Dec 31, 2016 Accepting new patients
Cep America-California CurrentSince Nov 15, 2014 Accepting new patients
Exer Medical Corporation CurrentSince Nov 1, 2025 Accepting new patients

Locations

26777 Agoura Rd
Ste 4
Calabasas, CA 91302
Phone (818) 880-2225

235 E 17th St
Costa Mesa, CA 92627
Phone (949) 688-2010

2381 Rosecrans Ave
Ste 115
El Segundo, CA 90245
Phone (213) 335-7355

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

7000 Boulder Ave
Ste 103
Highland, CA 92346
Phone (515) 441-6271

1407 Foothill Blvd
La Verne, CA 91750
Phone (909) 596-3577

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 350-2663

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

4445 Magnolia Ave
Riverside, CA 92501
Phone (800) 498-7156

25548 The Old Rd
Ste U1
Stevenson Ranch, CA 91381
Phone (661) 556-9020

701 N Wendy Dr
Thousand Oaks, CA 91320
Phone (805) 375-4400

14011 Park Ave
Victorville, CA 92392
Phone (760) 843-2015

33494 Oak Glen Rd
Yucaipa, CA 92399
Phone (909) 797-8900

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1411516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761091200000",
    "number": "1811399645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16840 CANYON VIEW DR",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925046252",
            "telephone_number": "951-733-9979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14011 PARK AVE",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923922413",
            "telephone_number": "951-788-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COFFEY",
        "first_name": "PATRICK",
        "middle_name": "JOHN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-09-24",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.