Kyla Ama Davis, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA19190 Issued in CA

Practice address

2141 N Harbor Blvd Ste 35000
Fullerton, CA 92835-3831

Phone

(714) 626-8630

NPI assigned

Apr 10, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Electronic endpoints 1

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

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence St. Jude Medical Center Hospital, Fullerton, CA, CCN 050168

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kdavis1373663@oc.providencedirect.org

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.

• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762
  Medicare reassignment Care Compare group
• Providence Medical Foundation

  • Surgery Physician
  • Eureka, CA
  • NPI 1477790517
  NPD

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

• St Jude Hospital Inc

  • General Acute Care Hospital
  • Fullerton, CA
  • NPI 1194926279
  Care Compare affiliation
• St Jude Hospital Inc

  • General Acute Care Hospital
  • Brea, CA
  • NPI 1891904942
  Care Compare affiliation

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603065600000",
    "number": "1972726784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1810",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922701059",
            "telephone_number": "760-568-2684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2141 N HARBOR BLVD STE 35000",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353831",
            "telephone_number": "714-626-8630"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2251 N Harbor Blvd",
            "address_purpose": "LOCATION",
            "city": "Fullerton",
            "state": "CA",
            "postal_code": "928352601",
            "country_code": "US",
            "telephone_number": "714-449-6230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "39000 Bob Hope Dr",
            "address_2": "Harry & Diane Rinker Building",
            "address_purpose": "LOCATION",
            "city": "Rancho Mirage",
            "state": "CA",
            "postal_code": "92270",
            "country_code": "US",
            "telephone_number": "760-568-2684",
            "fax_number": "760-837-2202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "KYLA",
        "middle_name": "AMA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-10",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA 9104116",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA19190",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA19190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "AW012X",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "AW012Y",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "AW012Z",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kyladavis@sjhhandhmg.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "2141 N Harbor Blvd Ste 35000",
            "city": "Fullerton",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928353831",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Annalisa Helen Davis
• Audra M Davis
• Cynthia Davis
• Dayna Juliette Davis
• Jordan Davis
• Nichole Davis, PA-S
• Sandra Lee Davis, PHARMD
• Shakira Davis
• Warren Davis, M.D.
• Gina Marie Daw, R.N., RNFA, FNP-C

• Medical Physician Assistant in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; 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.