Athena Marie Keobounnam, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA63422 Issued in CA

Practice address

7257 N Fresno St
Fresno, CA 93720-2950

Phone

(559) 227-7463

NPI assigned

Sep 20, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Health PartnersGroup PAC ID 6608280268, 497 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Community Regional Medical Center Hospital, Fresno, CA, CCN 050060
• Clovis Community Medical Center Hospital, Clovis, CA, CCN 050492
• Saint Agnes Medical Center Hospital, Fresno, CA, CCN 050093

Merit-based Incentive Payment System (MIPS)

Final score

92.04 of 100Reported as group

Quality

78.62

Promoting interoperability

100

Improvement activities

40

Cost

75.31

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 and National Provider Directory roles.

• Community Health Partners

  • Multi-Specialty Clinic/Center
  • Fresno, CA
  • NPI 1952912420
  Medicare reassignment Care Compare group NPD

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

• Fresno Community Hospital and Medical Center

  • General Acute Care Hospital
  • Fresno, CA
  • NPI 1104906569
  Care Compare affiliation
• Fresno Community Hospital and Medical Center

  • General Acute Care Hospital
  • Clovis, CA
  • NPI 1316027709
  Care Compare affiliation
• Saint Agnes Medical Center

  • General Acute Care Hospital
  • Fresno, CA
  • NPI 1205845567
  Care Compare affiliation

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

{
    "created_epoch": "1695168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1982482816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7257 N FRESNO ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937202950",
            "telephone_number": "559-227-7463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7257 N FRESNO ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937202950",
            "telephone_number": "559-227-7463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEOBOUNNAM",
        "first_name": "ATHENA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-20",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA63422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maureen Kent, LCSW
• Kenty U Sian MD Inc
• Tamar Marie Kenworthy, PSYD
• Sommy Keo
• Suwan Keo
• Anastasia Keoniyom
• Kepler Education Incorporation
• Kermit Koontz Education Center
• Curtis Perry Kerner
• Khairi Davia Kerney

• Surgical Physician Assistant in Fresno, CA
• Providers in Fresno, CA by specialty
• Surgical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; 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.