Shannon Bagnasco

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95000377 Issued in CA

Practice address

26926 Cherry Hills Blvd
Suite B
Menifee, CA 92586-2500

Phone

(951) 216-2200

NPI assigned

Feb 24, 2014

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

Medicare enrollment (NPD)

Enrolled

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.

• Elizabeth Supportive Medical Specialists, a Medical Corporation

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Escondido, CA
  • NPI 1154861979
  Medicare reassignment NPD

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

{
    "created_epoch": "1393200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393200000000",
    "number": "1235554510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 N DATE ST",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920253413",
            "telephone_number": "760-737-6960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26926 CHERRY HILLS BLVD",
            "address_2": "SUITE B",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "925862500",
            "telephone_number": "951-216-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGNASCO",
        "first_name": "SHANNON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-24",
        "last_updated": "2014-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95000377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Avila
• Christina Destiny Avina
• Stephanie Avina
• Lauren Mirelle Azantian, LCSW
• Dorilynn Bagby
• Monica M Bahena
• Raymond Bailey-Gutierrez
• Baker Pediatric Dental Care
• Ryan Baker
• Nancy Baldwin, OT

• Family Nurse Practitioner in Menifee, CA
• Providers in Menifee, 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 Feb 24, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.