Jennifer Rusnanto NG, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95009670 Issued in CA

Practice address

29525 Canwood St Ste 200
Agoura Hills, CA 91301-4230

Phone

(818) 699-6553

NPI assigned

Oct 10, 2019

Last updated

May 13, 2020By the provider in NPPES

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 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

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carbon Health Medical Group of California PCGroup PAC ID 9032340047, 335 clinicians

SC Medical, Inc.Group PAC ID 6305001439, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Carbon Health Medical Group of California PC

  dba Carbon Health

  • Urgent Care Clinic/Center
  • Berkeley, CA
  • NPI 1417294232
  Medicare reassignment Care Compare group NPD
• SC Medical, Inc.

  dba AFC Urgent Care of Santa Clarita

  • Urgent Care Clinic/Center
  • Santa Clarita, CA
  • NPI 1992078000
  Medicare reassignment Care Compare group NPD
• Rapid Response Urgent Care, Inc

  • Urgent Care Clinic/Center
  • Granada Hills, CA
  • NPI 1871369553
  Medicare reassignment NPD
• Carbon Health Medical Group of California PC

  dba Carbon Health

  • Urgent Care Clinic/Center
  • Pasadena, CA
  • NPI 1255957205
  NPD
• SC Medical, Inc.

  dba AFC Urgent Care of Santa Clarita

  • Urgent Care Clinic/Center
  • Valencia, CA
  • NPI 1346834694
  NPD
• Ame Medical Group Inc

  • Family Medicine Physician
  • Downey, CA
  • NPI 1861711863
  NPD (past)
• Carbon Health Primary Care of California PC

  • Multi-Specialty Clinic/Center
  • Berkeley, CA
  • NPI 1972057990
  NPD (past)
• Zak Dental Corp

  dba Dr. Zak Sea Breeze Dental Care

  • Dentist
  • Agoura Hills, CA
  • NPI 1679813471
  NPD (past)

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

{
    "created_epoch": "1570665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589328000000",
    "number": "1225670318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29525 CANWOOD ST STE 200",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913014230",
            "telephone_number": "818-699-6553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29525 CANWOOD ST STE 200",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913014230",
            "telephone_number": "818-699-6553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NG",
        "first_name": "JENNIFER",
        "middle_name": "RUSNANTO",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-10",
        "last_updated": "2020-05-13",
        "certification_date": "2020-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95009670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nathan Rabizadeh DDS, Inc
• Ramin Aaron Naziri, DDS
• New Views Psychological Services
• Newlife Infusion Center
• Gary David Newquist, PH.D.
• Nina Levy, M.D., Professional Medical Corporation (MediWellness, Inc)
• Sherry Ann Norris, LMFT
• Numen Behavioral Health, LLC
• Eric Quintero Nunez, LMFT
• Nurses Choice Hospice Care Inc. (Affinity Healthcare Resources)

• Family Nurse Practitioner in Agoura Hills, CA
• Providers in Agoura Hills, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2020; 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.