KELLIE JOHNSON MATUSALEM MS, PA-C
NPI 1194121954
Physician Assistant in San Diego, CA
About Kellie Johnson Matusalem Ms, Pa-c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLIE JOHNSON MATUSALEM MS, PA-C (NPI 1194121954) is an individual physician assistant in San Diego, California, licensed in California (51956) and active in the NPI registry since November 2014. She is enrolled in Medicare PECOS and is a graduate of Other (2014).
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Kellie Johnson Matusalem Ms, Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 92111 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 11
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SAN DIEGO, CA 92111
SAN DIEGO, CA 92111
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kellie Matusalem's NPI number?
The NPI number for Kellie Matusalem is 1194121954. It was assigned to this individual provider in the NPPES registry on November 6, 2014. The provider is also known as Kellie Johnson.
Where is Kellie Matusalem located?
Kellie Matusalem practices at 3750 Convoy St Ste 201, San Diego, CA 92111. The listed phone number is (858) 278-8300.
What is Kellie Matusalem's specialty?
The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.
Is Kellie Matusalem enrolled in Medicare?
Yes. Kellie Matusalem is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
When was this NPI record last updated?
The NPPES record for Kellie Matusalem was last updated on December 21, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Kellie Johnson Matusalem, MS, PA-C · NPI 1194121954
Physician Assistant physician in San Diego, California. Individual provider, active in the CMS NPPES registry since November 6, 2014.
## Identity
- **NPI:** 1194121954 (Entity type: Individual)
- **Enumerated:** November 6, 2014
- **Primary specialty:** Physician Assistant · taxonomy 363A00000X
- **State license:** 51956 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 3750 CONVOY ST STE 201, San Diego, CA 92111-3770
- **Phone:** (858) 278-8300
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Medical school:** Other, class of 2014
## Record status
- **NPPES last updated:** December 21, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1194121954) · Data from the CMS NPPES public registry.