Kristin Mickelson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

585 N Mountain Ave
Suite a
Upland, CA 91786-8516

Phone

(909) 946-2228

Fax

(909) 946-8007

NPI assigned

Sep 11, 2015

Last updated

Oct 22, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Skinphysicians and Surgeons Medical Group IncGroup PAC ID 3971401126, 6 clinicians

Forefront Dermatology - Pacific, P.C.Group PAC ID 8325946015, 25 clinicians

Practice addresses (Care Compare)

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.

• Forefront Dermatology - Pacific, P.C.

  dba Forefront Dermatology

  • Dermatology Physician
  • Thousand Oaks, CA
  • NPI 1356535009
  Medicare reassignment Care Compare group NPD (past)
• Skinphysicians & Surgeons Medical Group, Inc.

  dba SkinPhysicians & Surgeons, A Forefront Dermatology Practice

  • Dermatology Physician
  • Upland, CA
  • NPI 1356411524
  Medicare reassignment Care Compare group
• Chaparral Medical Group, Inc.

  • Orthopaedic Surgery Physician
  • Pomona, CA
  • NPI 1477733624
  Medicare reassignment
• Chaparral Medical Group Inc.

  • Cardiovascular Disease Physician
  • Upland, CA
  • NPI 1639869605
  NPD
• Chaparral Medical Group, Inc.

  • Internal Medicine Physician
  • Pomona, CA
  • NPI 1437111028
  NPD
• Forefront Dermatology - Pacific, P.C.

  dba SkinPhysicians & Surgeons, A Forefront Dermatology Practice

  • Dermatology Physician
  • Chino, CA
  • NPI 1013743079
  NPD
• Forefront Dermatology - Pacific, P.C.

  dba SkinPhysicians & Surgeons, A Forefront Dermatology Practice

  • Dermatology Physician
  • Upland, CA
  • NPI 1487480448
  NPD
• San Antonio Regional Hospital

  • General Acute Care Hospital
  • Upland, CA
  • NPI 1780681189
  NPD (past)

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

{
    "created_epoch": "1441929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445472000000",
    "number": "1982072682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 TOWNE CENTER DR",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917675900",
            "telephone_number": "909-398-1550",
            "fax_number": "909-398-1573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "585 N MOUNTAIN AVE",
            "address_2": "SUITE A",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917868516",
            "telephone_number": "909-946-2228",
            "fax_number": "909-946-8007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKELSON",
        "first_name": "KRISTIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-11",
        "last_updated": "2015-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michael Chai MD Inc
• Michael Le DO Professional Medical Corporation (Ethos Medical Wellness Clinic)
• Michael N. Wood, M.D., Inc
• Toby Miclat
• Jazmin Middlebrook
• Roberta Miguel
• Milescare Homehealth Services, Inc.
• Miller Optical

• Medical Physician Assistant in Upland, CA
• Providers in Upland, 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 22, 2015; 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.