Individual provider Active NPI

Jacqueline Cheramie

  • Nurse Practitioner
  • Glendora, CA
National Provider Identifier
1306484514
Registry record updated Oct 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95030363 Issued in CA
Practice address
415 W Route 66 Ste 202
Glendora, CA 91740-4335
Phone
(626) 963-4467
NPI assigned
Dec 18, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 95030363 CA Primary

Addresses

Primary practice location

415 W Route 66 Ste 202
Glendora, CA 91740-4335

Mailing address

1161 E Covina Blvd
Covina, CA 91724-1523
Phone (626) 859-5277

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
I20250527002644 CA Practitioner - Nurse Practitioner 4880113414

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Willow Nursing Corp Psychiatric/Mental Health Current Accepting new patients
J M Geiss DO Apc CurrentSince May 12, 2025 Accepting new patients

Locations

415 W Route 66
Ste 202
Glendora, CA 91740

520 Superior Ave
Ste 255
Newport Beach, CA 92663
Phone (949) 720-9266

5 Hutton Centre Dr
Ste 950
Santa Ana, CA 92707
Phone (855) 434-7663

28650 Newhall Ranch Rd
Santa Clarita, CA 91355
Phone (661) 347-0051

Organizations & group practices 2

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": "1576627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760313600000",
    "number": "1306484514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1161 E COVINA BLVD",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917241523",
            "telephone_number": "626-859-5277",
            "fax_number": "626-608-2645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 W ROUTE 66 STE 202",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917404335",
            "telephone_number": "626-963-4467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHERAMIE",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-18",
        "last_updated": "2025-10-13",
        "certification_date": "2025-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95030363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendora, CA

Sources for this page

Verify at the official NPI Registry.