Sonia Ildelisa Betancourt, FNP-C
Individual provider Active NPI Family Nurse Practitioner · San Jacinto, CA
NPI 1023628435 · NPPES record last updated Dec 8, 2021
Key facts
- NPI
- 1023628435
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- NP95014929 (CA)
- Practice address
- 621 N State St
San Jacinto, CA 92583-6567 - Phone
- (951) 285-6115
- NPI assigned
- Aug 1, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southern California Permanente Medical Group
Practice addresses (Care Compare)
10800 Magnolia Ave
Riverside, CA 92505-3043
Phone (951) 353-2000
2055 Kellogg Ave
Corona, CA 92879-3111
Phone (866) 984-7483
3951 Van Buren Blvd
Riverside, CA 92503-3620
Phone (909) 352-7002
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 |
|---|---|---|---|---|
| I20201123002910 | CA | Practitioner - Nurse Practitioner | 5597176578 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP95014929 | CA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current |
Accepting new patients |
Locations
10800 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | NP95014929 | CA | Yes |
Addresses
Primary practice location
621 N State St
San Jacinto, CA 92583-6567
Mailing address
621 N State St Ste 3
San Jacinto, CA 92583-6568
Phone (951) 652-6522
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) | Southern California Permanente Medical Group |
Other providers in San Jacinto, CA
- Briana Ruth Bender
- Edralyn Asnan Benitez
- Nicol Bergeron-Ransom
- Mario Bermudez
- Best Choice Congregate Living
- Betty G. Gibbel Regional Learning Center
- Betty G. Gibbel Regional Learning Center
- Tonja McHenry Bey
- Jennifer Lynn Bigney
- Bii Aj Our House, LLC
All providers in San Jacinto, CA · Family 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 Dec 8, 2021. 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.