Individual provider Active NPI

Kelly Lee Santoro, PA

  • Physician Assistant
  • Los Angeles, CA
National Provider Identifier
1982960340
Registry record updated Feb 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
51687 Issued in CA
Practice address
12414 Exposition Blvd
Los Angeles, CA 90064-1016
Phone
(310) 272-7640
Fax
(310) 272-7656
NPI assigned
Apr 10, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA055445 PA
Medical Physician Assistant 363AM0700X 51687 CA
Physician Assistant 363A00000X 51687 CA Primary

Addresses

Primary practice location

12414 Exposition Blvd
Los Angeles, CA 90064-1016

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (310) 272-7648

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kelly.santoro@direct.usc.edu Direct

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141028001228 CA Practitioner - Physician Assistant 0547423360 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Yale University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Saint Johns Medical FoundationGroup PAC ID 0840548624, 282 clinicians

Practice addresses (Care Compare)

12414 Exposition Blvd
Los Angeles, CA 90064-1016
Phone (310) 272-7640

2336 Santa Monica Blvd
Suite 204
Santa Monica, CA 90404-2938
Phone (310) 829-6789

Hospital & facility affiliations

  • Saint John'S Health Center Hospital, Santa Monica, CA, CCN 050290
  • Cedars-Sinai Medical Center Hospital, Los Angeles, CA, CCN 050625

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
51687CAMDPhysician Assistant
MA055445PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Usc Care Medical Group, Inc CurrentSince Sep 1, 2014 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Sep 1, 2014 Accepting new patients
Cedars-Sinai Medical Center Past Accepting new patients
Providence Saint John'S Health Center Past Accepting new patients

Locations

9033 Wilshire Blvd
Ste 300
Beverly Hills, CA 90211
Phone (310) 273-0330

12414 Exposition Blvd
Los Angeles, CA 90064
Phone (310) 272-7640

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

2121 Santa Monica Blvd
Santa Monica, CA 90404
Phone (310) 281-2024

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: kelly.santoro@direct.usc.edu

Organizations & group practices 5

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1334016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1982960340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "310-272-7648",
            "fax_number": "310-272-7656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12414 EXPOSITION BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900641016",
            "telephone_number": "310-272-7640",
            "fax_number": "310-272-7656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTORO",
        "first_name": "KELLY",
        "middle_name": "LEE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-10",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA055445",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "51687",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "51687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kelly.santoro@direct.usc.edu",
            "affiliation": "Y",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "12414 Exposition Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900641016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.