Kelsie Midori Shimizu

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA60125 Issued in CA

Practice address

125 W Huntington Dr BLDG A200
Arcadia, CA 91007-3050

Phone

(323) 442-5790

NPI assigned

Nov 22, 2020

Last updated

Feb 16, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Eastern Virginia Medical School, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Usc Care Medical Group IncGroup PAC ID 0446157747, 1,378 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Keck Hospital of Usc Hospital, Los Angeles, CA, CCN 050696
• Usc Kenneth Norris Jr Cancer Hospital Hospital, Los Angeles, CA, CCN 050660
• Usc Arcadia Hospital Hospital, Arcadia, CA, CCN 050238

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Usc Care Medical Group, Inc

  • General Practice Physician
  • Los Angeles, CA
  • NPI 1902846306

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Ritvik Mehta, MD Apc

  dba California Head & Neck Specialists

  • Otolaryngology Physician
  • Carlsbad, CA
  • NPI 1538302997
  Medicare reassignment
• Usc Care Medical Group, Inc

  dba Fair Oaks Clinic

  • Durable Medical Equipment & Medical Supplies
  • Pasadena, CA
  • NPI 1427937390
  NPD
• Usc University Hospital, Inc.

  dba USC Hospital

  • Psychiatric Hospital Unit
  • Los Angeles, CA
  • NPI 1790718500
  NPD (past)
• Usc Verdugo Hills Hospital, LLC

  dba Verdugo Hills Hospital

  • General Acute Care Hospital
  • Glendale, CA
  • NPI 1265875207
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Keck Medical Center of Usc

  dba Keck Hospital of USC

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1013514199
  Care Compare affiliation
• Keck Medical Center of Usc

  dba USC Kenneth Norris Jr. Hospital

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1417554528
  Care Compare affiliation
• Usc Arcadia Hospital

  • General Acute Care Hospital
  • Arcadia, CA
  • NPI 1508851288
  Care Compare affiliation

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

{
    "created_epoch": "1606003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1972107811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 W HUNTINGTON DR",
            "address_2": "BLDG A200",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910073050",
            "telephone_number": "323-442-5790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 W HUNTINGTON DR BLDG A200",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910073050",
            "telephone_number": "323-442-5790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIMIZU",
        "first_name": "KELSIE",
        "middle_name": "MIDORI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-22",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA60125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherilyn H Fox, LMFT LLC
• Albert Shieh, LAC
• Shigeo Kuwahara, M.D.
• Lucy Shih, M.D.
• Vivian Wen-Jieh Shih, O.D.
• Jin Shin
• Andrew Isao Shiroishi, PHARMD
• Lynetta Arnise Shonibare, PSY.D.
• Shu Shanti 3, Inc
• Annie T.S. Shu, M.D.

• Physician Assistant in Arcadia, CA
• Providers in Arcadia, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; 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.

Verify at the official NPI Registry.