Active NPI
Randi Kaitlin Wirfel, PA-C
- Physician Assistant
- San Jose, CA
National Provider Identifier
1811620800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 1066 S White Rd
San Jose, CA 95127-3812 - Phone
- (408) 729-9700
- NPI assigned
- Jul 6, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
1066 S White Rd
San Jose, CA 95127-3812
Mailing address
2565 Skylark Dr
San Jose, CA 95125-2942
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240104000143 | CA | Order and Referring Only - Physician Assistant | 2769833706 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63026 | CA | MD | Oral and Maxillofacial Surgery (Dentist) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1657065600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700524800000",
"number": "1811620800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2565 SKYLARK DR",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951252942"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1066 S WHITE RD",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951273812",
"telephone_number": "408-729-9700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIRFEL",
"first_name": "RANDI",
"middle_name": "KAITLIN",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-07-06",
"last_updated": "2023-11-21",
"certification_date": "2023-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.