Individual provider Active NPI

Megg U Sofeso, FNP

  • Family Nurse Practitioner
  • Riverside, CA
National Provider Identifier
1134629629
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95008227 Issued in CA
Practice address
4310 Orange St
Riverside, CA 92501-3829
Phone
(951) 781-6335
Fax
(951) 781-6335
NPI assigned
Feb 20, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 785560 CA
Family Nurse Practitioner 363LF0000X 95008227 CA Primary

Addresses

Primary practice location

4310 Orange St
Riverside, CA 92501-3829

Mailing address

4310 Orange St
Riverside, CA 92501-3829
Phone (951) 781-6335

Other practice location 1

4244 Riverwalk Pkwy Ste 150
Riverside, CA 92505-3373
Phone (951) 781-6335

Other identifiers 3

IdentifierTypeStateIssuer
95008227OtherCANURSE PRACTITIONER FURNISHING LICENSE
D1916442OtherCACA DRIVERS LICENSE
785560OtherCALICENSE - RN

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
I20191024002049 CA Practitioner - Nurse Practitioner 7618209651 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
95008227CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Family Physicians, a Professional Medical Corporation CurrentSince Aug 17, 2019 Accepting new patients

Locations

4310 Orange St
Riverside, CA 92501
Phone (951) 781-6335

3400 Central Ave
Ste 235
Riverside, CA 92506

4244 Riverwalk Pkwy
Ste 150
Riverside, CA 92505
Phone (951) 335-4660

Interoperability endpoints

  • Direct secure messaging: megg.sofeso.p2@direct.famdoc.nextgenshare.com
  • Direct secure messaging: megg.sofeso.p1@direct.famdoc.nextgenshare.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1519084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1134629629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 ORANGE ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925013829",
            "telephone_number": "951-781-6335",
            "fax_number": "951-228-0052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 ORANGE ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925013829",
            "telephone_number": "951-781-6335",
            "fax_number": "951-781-6335"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4244 Riverwalk Pkwy Ste 150",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925053373",
            "country_code": "US",
            "telephone_number": "951-781-6335",
            "fax_number": "951-781-6365",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOFESO",
        "first_name": "MEGG",
        "middle_name": "U",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-20",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "785560",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95008227",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTITIONER FURNISHING LICENSE",
            "identifier": "95008227",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA DRIVERS LICENSE",
            "identifier": "D1916442",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE - RN",
            "identifier": "785560",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.