Individual provider Active NPI

Michelle Erin Quon-Otsuji, FNP

  • Family Nurse Practitioner
  • Moreno Valley, CA
National Provider Identifier
1154972057
Registry record updated Oct 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95012862 Issued in CA
Practice address
26600 Cactus Ave Ste 300
Moreno Valley, CA 92555-3901
Phone
(951) 486-4000
NPI assigned
Sep 23, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95012862 CA Primary

Addresses

Primary practice location

26600 Cactus Ave Ste 300
Moreno Valley, CA 92555-3901

Mailing address

26600 Cactus Ave Ste 300
Moreno Valley, CA 92555-3901
Phone (951) 486-4000

Other names 1

  • Michelle Erin Quon Former name

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
I20200626002261 CA Practitioner - Nurse Practitioner 2466874011 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of RiversideGroup PAC ID 6507754488, shared by 16 NPIs, 190 clinicians

Practice addresses (Care Compare)

26600 Cactus Ave
Moreno Valley, CA 92555-3901

Hospital & facility affiliations

  • Newline Home Health and Palliative Care, Inc. Home health agency, Colton, CA, CCN 559266
  • Riverside University Health System-Medical Center Hospital, Moreno Valley, CA, CCN 050292

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
95012862CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Via Care Community Health Center CurrentSince Nov 22, 2021 Accepting new patients
Via Care Community Health Center CurrentSince Nov 22, 2021 Accepting new patients

Locations

501 S Atlantic Blvd
Los Angeles, CA 90022
Phone (323) 268-5442

607 S Atlantic Blvd
Los Angeles, CA 90022
Phone (213) 327-7828

507 S Atlantic Blvd
Los Angeles, CA 90022
Phone 32326891911067

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: mquonotsuji1222471@direct.llu.edu

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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": "1569196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728864000000",
    "number": "1154972057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26600 CACTUS AVE STE 300",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925553901",
            "telephone_number": "951-486-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26600 CACTUS AVE STE 300",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925553901",
            "telephone_number": "951-486-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUON-OTSUJI",
        "first_name": "MICHELLE",
        "middle_name": "ERIN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-23",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95012862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "QUON",
            "middle_name": "ERIN",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Moreno Valley, CA

Sources for this page

Verify at the official NPI Registry.