Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kellie Johnson Matusalem, MS, PA-C

Individual provider Physician Assistant · NPI 1194121954

Kellie Johnson Matusalem, MS, PA-C is a Physician Assistant in San Diego, California. Qualified in 2014, 12 years ago. Practices with Southern California Permanente Medical Group, an 11,242-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
12
Licensed in
CA
In the registry since
2014
What do these letters mean?
MS — Master of Science
A graduate science degree.
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

3750 Convoy St Ste 201
San Diego, CA 92111-3770
Phone: (858) 278-8300
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 51956 (CA)

Record details

NPI number1194121954
Entity typeIndividual (Type 1)
GenderFemale
Credentials MS , PA-C
Sole proprietorNo
NPI enumeratedNovember 6, 2014
Last updated in NPPESDecember 21, 2021
Certification dateDecember 21, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Southern California Permanente Medical Group — 11242 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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