Active NPI
Jason Kenneth Agustin, PA-C
- Medical Physician Assistant
- San Gabriel, CA
National Provider Identifier
1861637274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA20040
- Practice address
- 136 Bridge St
San Gabriel, CA 91775-2720 - Phone
- (562) 833-0184
- NPI assigned
- Dec 15, 2008
- Last updated
- May 5, 2023
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA20040 | CA | Primary |
Addresses
Primary practice location
136 Bridge St
San Gabriel, CA 91775-2720
Mailing address
136 Bridge St
San Gabriel, CA 91775-2720
Phone (562) 833-0184
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
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
401 S la Brea Ave
Inglewood, CA 90301-2321
Phone (310) 275-7575
Hospital & facility affiliations
- Southern California Hospital at Hollywood
- L a Downtown Medical Center
- Kaiser Foundation Hospital - West la
- Centinela Hospital Medical Center
- College Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Promoting interoperability
- 100
- Improvement activities
- 40
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20040 | CA | MD | Professional Counselor |
| PA20040 | CA | MD | Medical Physician Assistant |
Organizations & group practices 2
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.
-
- Pulmonary Disease Physician
- Inglewood, CA
- NPI 1164593323
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Kaiser Foundation Hospital West Los Angeles
- General Acute Care Hospital
- Los Angeles, CA
- NPI 1134274897
-
- General Acute Care Hospital
- Los Angeles, CA
- NPI 1780183335
-
- Rehabilitation Hospital Unit
- Los Angeles, CA
- NPI 1982351565
-
dba Centinela Hospital Medical Center
- General Acute Care Hospital
- Inglewood, CA
- NPI 1336328244
-
dba Southern California Hospital at Hollywood, at Van Nuys, at Culver City
- General Acute Care Hospital
- Hollywood, CA
- NPI 1023010113
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683244800000",
"number": "1861637274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "136 BRIDGE ST",
"city": "SAN GABRIEL",
"state": "CA",
"postal_code": "917752720",
"telephone_number": "562-833-0184"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "136 BRIDGE ST",
"city": "SAN GABRIEL",
"state": "CA",
"postal_code": "917752720",
"telephone_number": "562-833-0184"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGUSTIN",
"first_name": "JASON",
"middle_name": "KENNETH",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-12-15",
"last_updated": "2023-05-05",
"certification_date": "2023-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CA",
"license": "PA20040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Gabriel, CA
- Advanced Imaging of Tracy LLC
- Advanced Medical and Healthcare Center
- Advanced Reproductive Healthcare Center
- Ag San Gabriel, LLC (Broadway Healthcare Center)
- Stacy Young NA Aguilar
- Ahmc San Gabriel Valley Medical (AHMC San Gabreil Valley Medical Center, LP)
- Ahmc San Gabriel Valley Medical
- Ahmc San Gabriel Valley Medical (AHMC San Gabriel Valley Medical Center)
- Ahmc San Gabriel Valley Medical Center, LP
- Ashley Ahuatzi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 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.
- 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.