Shelley R Hasselman – Primary Care Nurse Practitioner

Key facts

NPI: 1003126129
Entity type: Individual (NPI type 1)
Primary specialty: Primary Care Nurse Practitioner 363LP2300X
License: 20149 (CA)
Practice address: 29099 Hospital Road
Suite 204B
Lake Arrowhead, CA 92352
Phone: (909) 337-7771
Fax: (909) 337-5353
NPI assigned: Oct 8, 2010
Sex: Female
Sole proprietor: Yes

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Southern California Emergency Medicine Urgent Care Clinic/Center · San Bernardino, CA · NPI 1639314255

Medicare reassignment Care Compare group NPD CA
Southern California Emergency Medicine Urgent Care Clinic/Center · Riverside, CA · NPI 1063191575

NPD
Southern California Emergency Medicine Urgent Care Clinic/Center · Redlands, CA · NPI 1457888034

NPD

Medicare Care Compare profile

Specialty: Nurse Practitioner
Education: Other, 2010
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Southern California Emergency Medicine (45 clinicians)

Practice addresses (Care Compare)

27640 Eucalyptus Ave
Moreno Valley, CA 92555-4557
Phone (951) 243-2200

301 W Redlands Blvd
Redlands, CA 92373-4633
Phone (909) 335-1900

33494 Oak Glen Rd
Yucaipa, CA 92399-2057
Phone (909) 797-8900

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
I20181212003116	CA	Practitioner - Nurse Practitioner	9436494846	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Nurse Practitioner

Practice roles

Organization	Status	New patients
Southern California Emergency Medicine	Current since Oct 1, 2018	Accepting new patients
Southern California Emergency Medicine	Current since Oct 1, 2018	Accepting new patients
Southern California Emergency Medicine	Current	Accepting new patients

Locations

1407 Foothill Blvd
La Verne, CA 91750
Phone (909) 596-3577

27640 Eucalyptus Ave
Moreno Valley, CA 92555
Phone (951) 243-2200

1295 Hamner Ave
Ste C
Norco, CA 92860
Phone (951) 272-6500

33494 Oak Glen Rd
Yucaipa, CA 92399
Phone (909) 797-8900

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Registered Nurse	163W00000X	626568	CA
Primary Care Nurse Practitioner	363LP2300X	20149	CA	Yes

Addresses

Primary practice location

29099 Hospital Road
Suite 204B
Lake Arrowhead, CA 92352

Mailing address

PO Box 2482
Running Springs, CA 92382-2482
Phone (909) 867-2814

Other providers in Lake Arrowhead, CA

All providers in Lake Arrowhead, CA · Primary Care Nurse Practitioner in California

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2010. 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).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.