Star Hildabrand, PA-C
Individual provider Active NPI Physician Assistant · Angels Camp, CA
NPI 1992750376 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1992750376
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA 12518 (CA)
- Practice address
- 222 S Main St
Angels Camp, CA 95222 - Phone
- (209) 736-0813
- NPI assigned
- May 23, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141208000396 | CA | Order and Referring Only - Physician Assistant | 6103821624 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA 12518 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mark Twain Medical Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA 12518 | CA | Yes |
Addresses
Primary practice location
222 S Main St
Angels Camp, CA 95222
Mailing address
PO Box 86
Avery, CA 95224-0086
Phone (209) 728-1694
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA 12518 | Other | CA | MEDICAL LICENSE NUMBER |
Other providers in Angels Camp, CA
- Gut Hormone Health LLC
- Rebecca Lynn Hancock
- Christina Hauer
- Gabriella Rose Gomez Hawkins
- Robert Shelby Haymond
- Kyrstyn Hildreth
- Chris H. Iwata
- Paul Allen Jacobson
- Priya Tara Johnston
- Laura Camille Jones
All providers in Angels Camp, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.