Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Kelly Rutherford S. Hall, PA-C

Individual provider Physician Assistant · NPI 1710989439

Mr. Kelly Rutherford S. Hall, PA-C is a Physician Assistant in Thousand Oaks, California. Qualified in 1993, 33 years ago. Practices with Golden State Providers, a Medical Corporation, a 23-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
33
Licensed in
CA
In the registry since
2005
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

227 W Janss Rd Ste 340
Thousand Oaks, CA 91360-1879
Phone: (805) 852-9100
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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 PA13266 (CA)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence PA13266 (CA)

Record details

NPI number1710989439
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedAugust 12, 2005
Last updated in NPPESMay 7, 2025
Certification dateMay 7, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 1993 (33 years in practice)
Group practice Golden State Providers, A Medical Corporation — 23 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Thousand Oaks