Individual provider Active NPI

Tyeshia Jones, NP-C, RNFA

  • Nurse Practitioner
  • Long Beach, CA
National Provider Identifier
1104276419
Registry record updated Jun 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95002786 Issued in CA
Practice address
1703 Termino Ave Ste 207
Long Beach, CA 90804
Phone
(562) 817-5602
Fax
(562) 817-5605
NPI assigned
Jun 16, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 95002786 CA Primary

Addresses

Primary practice location

1703 Termino Ave Ste 207
Long Beach, CA 90804

Mailing address

1703 Termino Ave Ste 207
Long Beach, CA 90804-2128
Phone (562) 817-5602

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20170926002317 CA Practitioner - Nurse Practitioner 7012281322 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mann and Jones Medical Group, IncGroup PAC ID 5496090193, 2 clinicians

Practice addresses (Care Compare)

1703 Termino Ave
Suite 207
Long Beach, CA 90804-2128
Phone (562) 817-5602

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95002786CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
First to Assist, LLC. Current Accepting new patients
Mervat S. Bakhoum, D.D.S. Past Accepting new patients

Locations

1703 Termino Ave
Ste 207
Long Beach, CA 90804
Phone (562) 597-8833

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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.

NPI Registry JSON

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530144000000",
    "number": "1104276419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1703 TERMINO AVE STE 207",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908042128",
            "telephone_number": "562-817-5602",
            "fax_number": "562-817-5605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 TERMINO AVE STE 207",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "90804",
            "telephone_number": "562-817-5602",
            "fax_number": "562-817-5605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "TYESHIA",
        "credential": "NP-C, RNFA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-16",
        "last_updated": "2018-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95002786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.