Individual provider Active NPI

Mary Kathryn Phillips, CNM

  • Advanced Practice Midwife
  • Temecula, CA
National Provider Identifier
1972583300
Registry record updated Nov 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
R0046429 Issued in OK
Practice address
43911 Running Brook Cir
Temecula, CA 92592-5663
Phone
(760) 521-4596
NPI assigned
Jan 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X R0046429 OK Primary

Addresses

Primary practice location

43911 Running Brook Cir
Temecula, CA 92592-5663

Mailing address

43911 Running Brook Cir
Temecula, CA 92592-5663
Phone (760) 521-4596

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150210001985 CA Practitioner - Certified Nurse Midwife (CNM) 2365767555 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
1811CAMDOccupational Therapy Assistant
R0046429OKMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Nov 26, 2014 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 26, 2014 Accepting new patients
Obhg California, P.C. CurrentSince Nov 1, 2025 Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 26, 2014 Accepting new patients
Temecula Valley OB GYN Medical Associates, Inc. Past Accepting new patients

Locations

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

1225 Wilshire Blvd
Los Angeles, CA 90017
Phone (213) 482-2741

333 Mercy Ave
Merced, CA 95340
Phone (209) 385-1280

25500 Medical Center Dr
Murrieta, CA 92562
Phone (951) 696-6000

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

39000 Bob Hope Dr
Rancho Mirage, CA 92270
Phone (760) 340-3911

10800 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2000

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21242/brand/1/csg/1/fhir/r4

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1972583300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43911 RUNNING BROOK CIR",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925925663",
            "telephone_number": "760-521-4596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43911 RUNNING BROOK CIR",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925925663",
            "telephone_number": "760-521-4596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "MARY",
        "middle_name": "KATHRYN",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-20",
        "last_updated": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "OK",
            "license": "R0046429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Temecula, CA

Sources for this page

Verify at the official NPI Registry.