Individual provider Active NPI

Viola Ninchak, FNP

  • Family Nurse Practitioner
  • La Jolla, CA
National Provider Identifier
1275007403
Registry record updated Nov 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95010549 Issued in CA
Practice address
9850 Genesee Ave Ste 530
La Jolla, CA 92037-1213
Phone
(760) 631-3000
Fax
(858) 412-5028
NPI assigned
Jan 22, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Psychiatric/Mental Health Registered Nurse 163WP0809X 95062783 CA
Family Nurse Practitioner 363LF0000X 95010549 CA Primary

Addresses

Primary practice location

9850 Genesee Ave Ste 530
La Jolla, CA 92037-1213

Mailing address

6010 Hidden Valley Rd Ste 200
Carlsbad, CA 92011-4219
Phone (760) 631-3000

Other practice location 1

15611 Pomerado Rd Ste 505
Poway, CA 92064-2437
Phone (760) 631-3000

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20210326002290 CA Practitioner - Nurse Practitioner 0244647857 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

400 Craven Rd
San Marcos, CA 92078-4201
Phone (619) 528-5000

4647 Zion Ave
San Diego, CA 92120-2507
Phone (619) 528-5000

4650 Palm Ave
San Diego, CA 92154-8404
Phone (619) 528-5000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
95010549CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Oct 31, 2022 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Oct 31, 2022 Accepting new patients

Locations

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

Organizations & group practices 3

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": "1548115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668988800000",
    "number": "1275007403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6010 HIDDEN VALLEY RD STE 200",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920114219",
            "telephone_number": "760-631-3000",
            "fax_number": "760-631-3016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9850 GENESEE AVE STE 530",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371213",
            "telephone_number": "760-631-3000",
            "fax_number": "858-412-5028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15611 Pomerado Rd Ste 505",
            "address_purpose": "LOCATION",
            "city": "Poway",
            "state": "CA",
            "postal_code": "920642437",
            "country_code": "US",
            "telephone_number": "760-631-3000",
            "fax_number": "858-312-1123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NINCHAK",
        "first_name": "VIOLA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-22",
        "last_updated": "2022-11-21",
        "certification_date": "2022-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "CA",
            "license": "95062783",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95010549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in La Jolla, CA

Sources for this page

Verify at the official NPI Registry.