STP Journey Gulles, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

95020502 Issued in CA

Practice address

4100 Latham St Ste E
Riverside, CA 92501-1733

Phone

(951) 393-1333

NPI assigned

May 10, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ehab Yacoub MD IncGroup PAC ID 5092099523, 179 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Ehab Yacoub MD Inc.

  • Child & Adolescent Psychiatry Physician
  • Gardena, CA
  • NPI 1417373713
  Medicare reassignment Care Compare group NPD
• Neuromatters and Wellness a Professional Nursing Practice Corporation

  • Psychiatry Physician
  • National City, CA
  • NPI 1538931993
  Medicare reassignment NPD
• Senior Doc Integrated Med, PC

  • Family Medicine Physician
  • Santa Ana, CA
  • NPI 1396526026
  Medicare reassignment NPD
• Holistic Alliance Nursing Pcorp

  • Adult Health Nurse Practitioner
  • National City, CA
  • NPI 1518851567
  NPD
• J M Geiss DO Apc

  • Family Medicine Physician
  • Santa Ana, CA
  • NPI 1063825289
  NPD
• Egb Holdings

  • Community Based Hospice Care Agency
  • Riverside, CA
  • NPI 1801345731
  NPD (past)
• Seasons Hospice & Palliative Care of California- San Bernardino, LLC

  • Community Based Hospice Care Agency
  • Ontario, CA
  • NPI 1336408848
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1013653286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 SHAFER CT STE 700",
            "city": "ROSEMONT",
            "state": "IL",
            "postal_code": "600184989",
            "telephone_number": "346-376-1702",
            "fax_number": "224-532-2780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 LATHAM ST STE E",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925011733",
            "telephone_number": "951-393-1333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16745 W Bernardo Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921271907",
            "country_code": "US",
            "telephone_number": "858-592-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GULLES",
        "first_name": "STP JOURNEY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-10",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "95020502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Guillen
• Guillermo J Gomez MD Inc
• Nikolas Andrew Guitron
• Raj Gulati, DO
• Amanda Mikayla Gull
• Sardar Gulraiz
• Sophia Christina Gumas, MD
• Bjorn Erik Gunnarsson, DPT
• Imani Nicole Gunter
• Sarah Elizabeth Guo-Rohe, PA-C

• Gerontology Nurse Practitioner in Riverside, CA
• Providers in Riverside, CA by specialty
• Gerontology Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (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.