Active NPI
Lillian Joy Hathaway, PA-C
- Physician Assistant
- Pomona, CA
National Provider Identifier
1962987198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 55913
- Practice address
- 1798 N Garey Ave
Pomona, CA 91767-2918 - Phone
- (909) 865-9500
- NPI assigned
- Oct 3, 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 | 55913 | CA | Primary |
Addresses
Primary practice location
1798 N Garey Ave
Pomona, CA 91767-2918
Mailing address
165 Tripps Corner Rd
Exeter, RI 02822-2937
Phone (401) 339-8854
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 55913 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cep America - California | Current | Accepting new patients | |
| First Aid Urgent Care Inc | Past | Accepting new patients |
Locations
1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423
1798 N Garey Ave
Pomona, CA 91767
Phone (909) 865-9810
Interoperability endpoints
- lillian.hathaway.1@31962.direct.athenahealth.com
- lillian.hathaway@398008301912068.direct.elationemr.com
Organizations & group practices 5
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.
-
- Emergency Medicine Physician
- Santa Ana, CA
- NPI 1548667843
-
- Surgery Physician
- Burbank, CA
- NPI 1437675980
-
- Surgery Physician
- Aliso Viejo, CA
- NPI 1629891676
-
- Emergency Medicine Physician
- Pomona, CA
- NPI 1740235258
-
- Urgent Care Clinic/Center
- Tujunga, CA
- NPI 1760889190
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538524800000",
"number": "1962987198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "165 TRIPPS CORNER RD",
"city": "EXETER",
"state": "RI",
"postal_code": "028222937",
"telephone_number": "401-339-8854"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1798 N GAREY AVE",
"city": "POMONA",
"state": "CA",
"postal_code": "917672918",
"telephone_number": "909-865-9500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HATHAWAY",
"first_name": "LILLIAN",
"middle_name": "JOY",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-03",
"last_updated": "2018-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "55913",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pomona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2018; 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.