Individual provider Active NPI

Barry G. Nieman, CPNP

  • Pediatric Nurse Practitioner
  • Loma Linda, CA
National Provider Identifier
1205957412
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
RN464104 Issued in CA
Practice address
11234 Anderson St
Loma Linda, CA 92354-2804
Phone
(909) 558-4000
Fax
(909) 558-7873
NPI assigned
Apr 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X RN464104 CA Primary

Addresses

Primary practice location

11234 Anderson St
Loma Linda, CA 92354-2804

Mailing address

25010 Prospect Ave
Loma Linda, CA 92354-2900
Phone (909) 796-5634

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
I20120719000210 CA Practitioner - Nurse Practitioner 4284890203 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN464104CAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Apr 18, 2017 Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Apr 18, 2017 Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Loma Linda University Medical Center Past Accepting new patients
Loma Linda University Children'S Hospital Past Accepting new patients
Faculty Physicians and Surgeons of Llusm Past Accepting new patients

Locations

11370 Anderson St
Ste 2600
Loma Linda, CA 92354
Phone (909) 558-2890

11234 Anderson St
#6200
Loma Linda, CA 92350
Phone (909) 558-4200

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

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

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

901 San Bernardino Rd
Ste 104
Upland, CA 91786
Phone (909) 542-2779

Interoperability endpoints

  • Direct secure messaging: bnieman9751@direct.llu.edu

Organizations & group practices 9

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": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205957412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25010 PROSPECT AVE",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542900",
            "telephone_number": "909-796-5634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542804",
            "telephone_number": "909-558-4000",
            "fax_number": "909-558-7873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIEMAN",
        "first_name": "BARRY",
        "middle_name": "G.",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "RN464104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.