Organization Active NPI

Proactive Care Nursing, Inc

  • Adult Health Nurse Practitioner
  • Huntington Beach, CA
National Provider Identifier
1154713790
Registry record updated Apr 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
Legal business name
PROACTIVE CARE NURSING, INC
Practice address
17822 Beach Blvd
Suite 400
Huntington Beach, CA 92647-7101
Phone
(714) 332-7016
NPI assigned
Feb 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2017

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

Authorized official

Name
Miss Sherry E DO, NPNPI 1205067543
Title
Coo
Phone
(714) 332-7016

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LA2200X Primary

Addresses

Primary practice location

17822 Beach Blvd
Suite 400
Huntington Beach, CA 92647-7101

Mailing address

8692 Wagers Cir
Huntington Beach, CA 92647-5027
Phone (714) 332-7016

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150601002130 CA Part B Supplier - Clinic/Group Practice 8628399714 Receives reassigned benefits from 8 practitioners
Practice locations: Huntington Beach, CA

National Provider Directory

National Provider Directory

Locations

17822 Beach Blvd
Ste 400
Huntington Beach, CA 92647
Phone (714) 332-7016

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1424217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491264000000",
    "number": "1154713790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8692 WAGERS CIR",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926475027",
            "telephone_number": "714-332-7016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17822 BEACH BLVD",
            "address_2": "SUITE 400",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926477101",
            "telephone_number": "714-332-7016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE CARE NURSING, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-18",
        "last_updated": "2017-04-04",
        "status": "A",
        "authorized_official_last_name": "DO",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "714-332-7016",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.