Jusac Arizthian Suryanata, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95031637 Issued in CA

Practice address

3308 Carolyn Cir
Oceanside, CA 92054-3844

Phone

(760) 658-4405

NPI assigned

Dec 20, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Datnguyen, M.D., Inc.Group PAC ID 4587668736, 16 clinicians

D William Nguyen MD ApcGroup PAC ID 6204280373, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jsuryanata47814@syhealth.direct-ci.com

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.

• Datnguyen MD Inc

  • Internal Medicine Physician
  • San Diego, CA
  • NPI 1215977723
  Medicare reassignment Care Compare group NPD
• D William Nguyen MD Apc

  • Psychiatry Physician
  • San Diego, CA
  • NPI 1457032732
  Medicare reassignment Care Compare group
• Carbon Medical Center

  • Internal Medicine Physician
  • San Diego, CA
  • NPI 1609678226
  Medicare reassignment NPD
• Centro de Salud de la Comunidad de San Ysidro, Inc.

  dba San Ysidro Health Precision Park

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1124782685
  Medicare reassignment NPD
• Centro de Salud de la Comunidad de San Ysidro Inc

  dba San Ysidro Health Senior Dental Center

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1457033813
  NPD
• Centro de Salud de la Comunidad de San Ysidro, Inc.

  dba San Ysidro Health Chula Vista

  • Federally Qualified Health Center (FQHC)
  • Chula Vista, CA
  • NPI 1326486861
  NPD

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

{
    "created_epoch": "1703030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1124897046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3308 CAROLYN CIR",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920543844",
            "telephone_number": "760-658-4405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3308 CAROLYN CIR",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920543844",
            "telephone_number": "760-658-4405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURYANATA",
        "first_name": "JUSAC",
        "middle_name": "ARIZTHIAN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-20",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95166131",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95031637",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA BRN",
            "identifier": "95166131",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA BRN",
            "identifier": "95031637",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sandra D Sundel, PH.D.
• Berk Tolga Suntay, MD
• Superior Home Care Services, Inc
• Arilda G Surridge, LMFT
• Janet Chebet Surum, RN
• Brittany Sustachek
• Sustain Wellness
• Rebecca Sutcliffe, CNM
• Amber Suttie, LVN
• Jenna Suway, PH.D.

• Psychiatric/Mental Health Nurse Practitioner in Oceanside, CA
• Providers in Oceanside, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 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.

Verify at the official NPI Registry.