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KELLY NISHIKAWA
NPI 1679004717
Student in an Organized Health Care Education/Training Program in Oakland, CA

Active since March 21, 2017PECOS EnrolledAccepts Medicare Assignment
275 W MACARTHUR BLVD, OAKLAND, CA 94611(510) 752-1000 Get Directions Write a Review

NPPES record last updated: December 3, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 3, 2021, Mar 21, 2017 (2 updates tracked since 2017).

About Kelly Nishikawa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY NISHIKAWA (NPI 1679004717) is an individual student in an organized health care education/training program in Oakland, California and active in the NPI registry since March 2017. She is enrolled in Medicare PECOS and is a graduate of Loma Linda University School Of Medicine (2017).

NPPES Registry Identity

NPI1679004717
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameKELLY NISHIKAWA
Location Address275 W MACARTHUR BLVDOakland, CA 94611-5641
Mailing Address275 W Macarthur BlvdOakland, CA 94611-5641
Phone(510) 752-1000
Sole ProprietorNo
Medical School CMSLoma Linda University School Of MedicineGraduated 2017
Enumeration DateMarch 21, 2017
Last NPPES UpdateDecember 3, 20212 updates tracked since enumeration
✔ NPI 1679004717 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
275 W MACARTHUR BLVD, Oakland, CA 94611
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kelly Nishikawa 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.

PECOS PAC ID9335488659
PECOS Enrollment IDI20201019002433
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kelly Nishikawa reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Southern California Permanente Medical Group
303 mi
Health Maintenance Organization
2103 E GONZALES RD
Oxnard, CA 93036
  • Reassigned Medicare billing, California enrollment
  • 13,921 clinicians in this Medicare group
NPI 1275756652 (805) 650-4700

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ANNA C. MORGAN MD
Specialist
275 W MACARTHUR BLVD
OAKLAND, CA 94611
Alameda County (510) 752-1000
DR. TRANG H. LA MD
Radiology (Radiation Oncology)
275 W MACARTHUR BLVD
OAKLAND, CA 94611
Alameda County (510) 752-1000
DR. AMIN MATIN M.D., M.P.H.
Radiology (Diagnostic Radiology)
275 W MACARTHUR BLVD
OAKLAND, CA 94611
Alameda County (925) 295-5758
SUCHETA KORWAR MD
Student in an Organized Health Care Education/Training Program
275 W MACARTHUR BLVD
OAKLAND, CA 94611
Alameda County (510) 752-1000
MR. MATTHEW GABRIELSON D.P.T.
Physical Therapist (Orthopedic)
275 W MACARTHUR BLVD
OAKLAND, CA 94611
Alameda County (510) 752-6221
MALORIE HACKER MD
Student in an Organized Health Care Education/Training Program
275 W MACARTHUR BLVD
OAKLAND, CA 94611
Alameda County (510) 752-1000
RENEE L. PERRY DO
Obstetrics & Gynecology
275 W MACARTHUR BLVD
OAKLAND, CA 94611
Alameda County (510) 752-1000
HERPRIT KAUR MAHAL MD
Hospitalist
275 W MACARTHUR BLVD
OAKLAND, CA 94611
Alameda County (510) 752-1000

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 Kelly Nishikawa's NPI number?

The NPI number for Kelly Nishikawa is 1679004717. It was assigned to this individual provider in the NPPES registry on March 21, 2017.

Where is Kelly Nishikawa located?

Kelly Nishikawa practices at 275 W Macarthur Blvd, Oakland, CA 94611. The listed phone number is (510) 752-1000.

What is Kelly Nishikawa's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Kelly Nishikawa enrolled in Medicare?

Yes. Kelly Nishikawa 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.

Which organization bills Medicare for Kelly Nishikawa's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Nishikawa reassigns Medicare benefits to Southern California Permanente Medical Group (Oxnard, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelly Nishikawa's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kelly Nishikawa was last updated on December 3, 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.