Active NPI
Kelli Smith
- Physician Assistant
- Menifee, CA
National Provider Identifier
1841771664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 30420 Haun Rd
Menifee, CA 92584-6810 - Phone
- (951) 676-4193
- NPI assigned
- Aug 29, 2018
- Sex
- Female
- Sole proprietor
- No
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
30420 Haun Rd
Menifee, CA 92584-6810
Mailing address
28780 Single Oak Dr Ste 160
Temecula, CA 92590-5528
Phone (951) 676-4193
Other practice location 1
28780 Single Oak Dr Ste 160
Temecula, CA 92590-5528
Phone (951) 676-4193
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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regents of the University of California | Past | Accepting new patients | |
| UC San Diego Health - Rancho Family Medical Group | Past | Accepting new patients | |
| Rincon Health Network | Past | Accepting new patients |
Organizations & group practices 4
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.
-
dba Platinum Women's Health and Wellness
- Family Medicine Physician
- Temecula, CA
- NPI 1598791600
-
dba Ucsd Medical Center Pharmacy
- Pharmacy
- San Diego, CA
- NPI 1598786576
-
- Health Service Clinic/Center
- Temecula, CA
- NPI 1902697832
-
- Multi-Specialty Clinic/Center
- Temecula, CA
- NPI 1003385071
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582156800000",
"number": "1841771664",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28780 SINGLE OAK DR STE 160",
"city": "TEMECULA",
"state": "CA",
"postal_code": "925905528",
"telephone_number": "951-676-4193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30420 HAUN RD",
"city": "MENIFEE",
"state": "CA",
"postal_code": "925846810",
"telephone_number": "951-676-4193"
}
],
"practiceLocations": [
{
"address_1": "28780 Single Oak Dr Ste 160",
"address_purpose": "LOCATION",
"city": "Temecula",
"state": "CA",
"postal_code": "925905528",
"country_code": "US",
"telephone_number": "951-676-4193",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SMITH",
"first_name": "KELLI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-29",
"last_updated": "2020-02-20",
"certification_date": "2020-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Menifee, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2020; 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.