Peter Paul Mutya Badua

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95030226 Issued in CA

Practice address

10621 Church St Ste 120
Rancho Cucamonga, CA 91730-6834

Phone

(909) 944-0486

NPI assigned

Dec 2, 2024

Sex

Male

Sole proprietor

Yes

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wound Masters Medical Group IncGroup PAC ID 8224307053, 12 clinicians

Wound Healing Care Specialists IncGroup PAC ID 5698019602, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Wound Healing Care Specialists, Inc.

  • Surgery Physician
  • Ontario, CA
  • NPI 1306317961

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Wound Masters Medical Group Inc

  • Surgery Physician
  • Ontario, CA
  • NPI 1376063461

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Rancho Wound Care Center, PC

  • Surgery Physician
  • Rancho Cucamonga, CA
  • NPI 1396548236

  Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1733097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733097600000",
    "number": "1043036429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 VIA NAPOLI",
            "city": "CATHEDRAL CITY",
            "state": "CA",
            "postal_code": "922344189",
            "telephone_number": "818-519-5373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10621 CHURCH ST STE 120",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917306834",
            "telephone_number": "909-944-0486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BADUA",
        "first_name": "PETER PAUL",
        "middle_name": "MUTYA",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-12-02",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95030226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bolaji Gabriel Babatunde, DHA, CPHQ
• Ranee Babu
• Ashley Bacci
• Rina C Bacot-Merriman
• Gabriela Badillo
• Kimberly Baer, LCSW
• Alex Baez
• Maria Angela Baglio
• Jeff Paul Bahra
• Shannon Baik

• Family Nurse Practitioner in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2024; 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.