Jasmina Santos Fornbacher, APRN

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

812066 Issued in NV

Practice address

7325 S Pecos Rd Ste 102
Las Vegas, NV 89120-3768

Phone

(702) 982-6402

Fax

(702) 202-0674

NPI assigned

Aug 9, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

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, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Chamian Medical Group PLLCGroup PAC ID 0941473177, 5 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Chamian Medical Group PLLC

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1629356274
  Medicare reassignment Care Compare group NPD
• Desert Springs Hospital

  dba Desert Springs Hospital Medical Center

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1154317964
  NPD (past)

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

{
    "created_epoch": "1533772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552867200000",
    "number": "1164901245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7325 S PECOS RD STE 102",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891203768",
            "telephone_number": "702-982-6402",
            "fax_number": "702-202-0674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7325 S PECOS RD STE 102",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891203768",
            "telephone_number": "702-982-6402",
            "fax_number": "702-202-0674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORNBACHER",
        "first_name": "JASMINA",
        "middle_name": "SANTOS",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-09",
        "last_updated": "2019-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NV",
            "license": "812066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kerri Shea Forman, CST, A.S.
• Abby Formica
• Agatha Matsos Formoso, MD
• Miriam Formoso
• Ciana Fornaris
• Roy Forner
• Jessica Fornes, RN
• Catrina Fornesi
• Kim R Forni
• Douglas Forrest

• Adult Health Nurse Practitioner in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Adult Health Nurse Practitioner in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2019; 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.