Active NPI
Xinjun Collagan, NP
- Nurse Practitioner
- Lake Elsinore, CA
National Provider Identifier
1114884681
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 95039100
- Practice address
- 578 Pablo Rd
Lake Elsinore, CA 92530-6804 - Phone
- (209) 207-1626
- NPI assigned
- Jan 7, 2026
- Last updated
- Mar 25, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 95039100 | CA | Primary |
Addresses
Primary practice location
578 Pablo Rd
Lake Elsinore, CA 92530-6804
Mailing address
578 Pablo Rd
Lake Elsinore, CA 92530-6804
Phone (209) 207-1626
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
507 S Douglas St
FL 3
El Segundo, CA 90245-4810
Phone (800) 985-5596
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95039100 | CA | MD | Nurse Practitioner |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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CA
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1767744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774396800000",
"number": "1114884681",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "578 PABLO RD",
"city": "LAKE ELSINORE",
"state": "CA",
"postal_code": "925306804",
"telephone_number": "209-207-1626",
"fax_number": "951-635-1004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "578 PABLO RD",
"city": "LAKE ELSINORE",
"state": "CA",
"postal_code": "925306804",
"telephone_number": "209-207-1626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLAGAN",
"first_name": "XINJUN",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-01-07",
"last_updated": "2026-03-25",
"certification_date": "2026-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "95039100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Elsinore, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2026; 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.