Active NPI
Nicolette Lujan
- Physician Assistant
- Rancho Mirage, CA
National Provider Identifier
1124616271
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 59404
- Practice address
- 71511 Highway 111 Ste H
Rancho Mirage, CA 92270-4465 - Phone
- (760) 773-2200
- NPI assigned
- Jan 5, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 59404 | CA | Primary |
Addresses
Primary practice location
71511 Highway 111 Ste H
Rancho Mirage, CA 92270-4465
Mailing address
71511 Highway 111 Ste H
Rancho Mirage, CA 92270-4465
Phone (760) 773-2200
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
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210524001529 | CA | Practitioner - Physician Assistant | 7214336270 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
71511 Hwy 111
Suite H
Rancho Mirage, CA 92270-4465
Phone (760) 773-2200
Hospital & facility affiliations
- Eisenhower Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 59404 | CA | MD | Dentist |
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 and National Provider Directory roles.
-
- Nephrology Physician
- Rancho Mirage, CA
- NPI 1295024933
CA
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744156800000",
"number": "1124616271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "71511 HIGHWAY 111 STE H",
"city": "RANCHO MIRAGE",
"state": "CA",
"postal_code": "922704465",
"telephone_number": "760-773-2200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "71511 HIGHWAY 111 STE H",
"city": "RANCHO MIRAGE",
"state": "CA",
"postal_code": "922704465",
"telephone_number": "760-773-2200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUJAN",
"first_name": "NICOLETTE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-05",
"last_updated": "2025-04-09",
"certification_date": "2025-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "59404",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Mirage, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2025; 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.