NPIMap

Individual provider Active NPI

Paul David Fry, PA-C

  • Medical Physician Assistant
  • Lompoc, CA
National Provider Identifier
1912961061
Registry record updated May 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
15416 Issued in CA
Practice address
1225 N H St
Lompoc, CA 93436
Phone
(805) 737-8700
NPI assigned
Apr 14, 2006
Last updated
May 13, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 15416 CA Primary

Addresses

Primary practice location

1225 N H St
Lompoc, CA 93436

Mailing address

1515 E Ocean Ave
Lompoc, CA 93436-7092
Phone (805) 737-8700

Other practice location 1

110 S 9th Ave
Yakima, WA 98902-3315
Phone (509) 575-5061

Other practice location 2

110 S 9th Ave
Yakima, WA 98902-3315
Phone (509) 575-5061

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110609000409 CA Practitioner - Physician Assistant 1557361961 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Physician Assistant

State licenses

LicenseStateTypeSpecialty
15416CAMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Lompoc Valley Medical Center CurrentSince Jan 15, 2019 Accepting new patients
Desert Springs Hospital Past Accepting new patients
Yakima Emergency Group a Professional Limited Liability Com Past Accepting new patients
Washoe Barton Medical Clinic a Nevada Nonprofit Corporation Past Accepting new patients
South Lyon Health Center, Inc. Past Accepting new patients
Dignity Health Past Accepting new patients
Lompoc Valley Medical Center Past Accepting new patients
Centennial Hills Hospital Medical Center Past Accepting new patients
Sparks Family Hospital Inc Past Accepting new patients
Prime Healthcare Services - Reno LLC Past Accepting new patients
Mt Grant General Hospital Past Accepting new patients
Sunrise Mountainview Hospital, Inc. Past Accepting new patients
Washington Em-I Medical Services PC Past Accepting new patients

Locations

1225 N H St
Lompoc, CA 93436
Phone (805) 737-8700

1515 E Ocean Ave
Lompoc, CA 93436
Phone (805) 737-3300

508 E Hickory Ave
Lompoc, CA 93436
Phone (805) 733-3333

Organizations & group practices 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557705600000",
    "number": "1912961061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 E OCEAN AVE",
            "city": "LOMPOC",
            "state": "CA",
            "postal_code": "934367092",
            "telephone_number": "805-737-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 N H ST",
            "city": "LOMPOC",
            "state": "CA",
            "postal_code": "93436",
            "telephone_number": "805-737-8700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 S 9th Ave",
            "address_purpose": "LOCATION",
            "city": "Yakima",
            "state": "WA",
            "postal_code": "989023315",
            "country_code": "US",
            "telephone_number": "509-575-5061",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "110 S 9th Ave",
            "address_purpose": "LOCATION",
            "city": "Yakima",
            "state": "WA",
            "postal_code": "989023315",
            "country_code": "US",
            "telephone_number": "509-575-5061",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FRY",
        "first_name": "PAUL",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2019-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "15416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lompoc, CA

Sources for this page

Verify at the official NPI Registry.