Individual provider Active NPI

Antonio Moreno

  • Certified Registered Nurse Anesthetist
  • San Bernardino, CA
National Provider Identifier
1154984706
Registry record updated Jan 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
95001104 Issued in CA
Practice address
2101 N Waterman Ave
San Bernardino, CA 92404-4836
Phone
(909) 883-8711
NPI assigned
Apr 18, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 95001104 CA Primary

Addresses

Primary practice location

2101 N Waterman Ave
San Bernardino, CA 92404-4836

Mailing address

25590 Prospect Ave Apt 25H
Loma Linda, CA 92354-3149
Phone (323) 440-1388

Other practice location 1

44139 Monterey Ave Ste B
Palm Desert, CA 92260-8700
Phone (760) 773-4411

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200124001482 CA Practitioner - Certified Registered Nurse Anesthetist (Crna) 9638504400 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Faculty Physicians and Surgeons of LlusmGroup PAC ID 1153227814, 1,313 clinicians
San Gabriel Anesthesia Associates, PCGroup PAC ID 3678720604, 16 clinicians

Practice addresses (Care Compare)

11234 Anderson St
Loma Linda, CA 92354-2804

11370 Anderson St
Loma Linda, CA 92354-3450

26780 Barton Rd
Redlands, CA 92373-4308
Phone (909) 558-5174

44139 Monterey Ave
Suite B
Palm Desert, CA 92260-8700
Phone (760) 779-5599

File Number
Suite 54701
Los Angeles, CA 90074-4701

Hospital & facility affiliations

  • Loma Linda University Medical Center Hospital, Loma Linda, CA, CCN 050327

Merit-based Incentive Payment System (MIPS)

Final score
88.87 of 100Reported as group
Quality
72.13
Promoting interoperability
80
Improvement activities
40
Cost
77.36

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Palm Springs Anesthesia Services, PC Anesthesiology CurrentSince Jan 13, 2020 Accepting new patients
San Gabriel Anesthesia Associates, PC Nurse Anesthetist, Certified Registered CurrentSince Oct 16, 2023 Accepting new patients
Faculty Physicians and Surgeons of Llusm Anesthesiology CurrentSince Aug 5, 2020 Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Aug 5, 2020 Accepting new patients
Loma Linda University Children'S Hospital Past Accepting new patients
Sda Services of Ca Anesthesiology Past Accepting new patients
Loma Linda University Medical Center Past Accepting new patients

Locations

288 N Santa Anita Ave
Ste 404
Arcadia, CA 91006
Phone (626) 289-2223

11370 Anderson St
#B100
Loma Linda, CA 92354
Phone (909) 558-2848

11234 Anderson St
Loma Linda, CA 92350
Phone (909) 558-3016

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

44139 Monterey Ave
Ste B
Palm Desert, CA 92260
Phone (760) 773-4411

1150 N Indian Canyon Dr
Palm Springs, CA 92262
Phone (760) 323-6251

2101 N Waterman Ave
Sn Bernrdno, CA 92404
Phone (909) 881-4305

1805 Medical Center Dr
Sn Bernrdno, CA 92411
Phone (909) 877-6333

Organizations & group practices 8

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 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": "1555545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738281600000",
    "number": "1154984706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25590 PROSPECT AVE APT 25H",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543149",
            "telephone_number": "323-440-1388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 N WATERMAN AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924044836",
            "telephone_number": "909-883-8711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "44139 Monterey Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Palm Desert",
            "state": "CA",
            "postal_code": "922608700",
            "country_code": "US",
            "telephone_number": "760-773-4411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MORENO",
        "first_name": "ANTONIO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-18",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CA",
            "license": "95001104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.