NPIMap

Individual provider Active NPI

Anna Marie Antonowich, MSN, NP-BC

  • Family Nurse Practitioner
  • Ukiah, CA
National Provider Identifier
1215063268
Registry record updated Mar 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
13718 Issued in CA
Practice address
260 Hospital Dr Ste 207
Ukiah, CA 95482-4568
Phone
(707) 463-7627
Fax
(707) 463-7420
NPI assigned
Feb 26, 2007
Last updated
Mar 22, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2023

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 13718 CA Primary

Addresses

Primary practice location

260 Hospital Dr Ste 207
Ukiah, CA 95482-4568

Mailing address

260 Hospital Dr Ste 207
Ukiah, CA 95482-4568
Phone (707) 463-7627

Other practice location 1

700 River Dr
Fort Bragg, CA 95437-5403
Phone (707) 961-4922

Other names 1

  • Ms. Anna Marie Antonowich-Jonsson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141021002269 CA Practitioner - Nurse Practitioner 6901027663 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ukiah Adventist HospitalGroup PAC ID 6406816123, 136 clinicians

Practice addresses (Care Compare)

275 Hospital Dr
Ukiah, CA 95482-4531
Phone (707) 462-3111

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.98 of 100Reported as group
Quality
73.31
Promoting interoperability
92
Improvement activities
40
Cost
62

Merit-based Incentive Payment System (MIPS)

Final score
88.16 of 100Reported as group
Quality
82.56
Promoting interoperability
93
Improvement activities
40
Cost
69.49

Merit-based Incentive Payment System (MIPS)

Final score
89.41 of 100Reported as group
Quality
86.32
Promoting interoperability
95
Improvement activities
40
Cost
66.55

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
13718CAMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Mendocino Coast CurrentSince Mar 3, 2022 Accepting new patients
Ukiah Adventist Hospital CurrentSince May 1, 2023 Accepting new patients
Adventist Health Mendocino Coast CurrentSince Mar 3, 2022 Accepting new patients
Ukiah Adventist Hospital CurrentSince May 1, 2023 Accepting new patients

Locations

700 River Dr
Fort Bragg, CA 95437
Phone (707) 961-1234

260 Hospital Dr
Ste 207
Ukiah, CA 95482
Phone (707) 463-7627

275 Hospital Dr
Ukiah, CA 95482
Phone (707) 462-7900

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/29a5ccea-f4ab-4447-a191-56b20695970f/

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679443200000",
    "number": "1215063268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 HOSPITAL DR STE 207",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824568",
            "telephone_number": "707-463-7627",
            "fax_number": "707-463-7420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 HOSPITAL DR STE 207",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824568",
            "telephone_number": "707-463-7627",
            "fax_number": "707-463-7420"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 River Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Bragg",
            "state": "CA",
            "postal_code": "954375403",
            "country_code": "US",
            "telephone_number": "707-961-4922",
            "fax_number": "707-961-4921",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANTONOWICH",
        "first_name": "ANNA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "MSN, NP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-26",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "13718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNA",
            "last_name": "ANTONOWICH-JONSSON",
            "middle_name": "MARIE",
            "prefix": "MS.",
            "credential": "MSN, NP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ukiah, CA

Sources for this page

Verify at the official NPI Registry.