Individual provider Active NPI

Mercy Egbujor, NP

  • Nurse Practitioner
  • San Jose, CA
National Provider Identifier
1326001439
Registry record updated Sep 14, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
481610 Issued in CA
Practice address
2011 Little Orchard St
Puentes Clinic-Internal Medicine
San Jose, CA 95125-1031
Phone
(408) 294-2100
NPI assigned
Apr 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2007

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 481610 CA Primary
Adult Health Nurse Practitioner 363LA2200X 481610 CA
Community Health Nurse Practitioner 363LC1500X 481610 CA

Addresses

Primary practice location

2011 Little Orchard St
Puentes Clinic-Internal Medicine
San Jose, CA 95125-1031

Mailing address

751 S Bascom Ave
San Jose, CA 95128-2604
Phone (408) 885-5000

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
I20110624000170 CA Practitioner - Nurse Practitioner 3274711106 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
481610CAMDCommunity Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
County of Santa Clara CurrentSince Mar 30, 2019 Accepting new patients
County of Santa Clara CurrentSince Mar 30, 2019 Accepting new patients
County of Santa Clara Current Accepting new patients
County of Santa Clara CurrentSince Aug 20, 2018 Accepting new patients
County of Santa Clara Current Accepting new patients
County of Santa Clara CurrentSince Aug 20, 2018 Accepting new patients

Locations

7475 Camino Arroyo
Gilroy, CA 95020
Phone (408) 852-2400

2101 Alexian Dr
San Jose, CA 95116
Phone (408) 272-6050

1996 Lundy Ave
San Jose, CA 95131
Phone (408) 299-5846

500 Tully Rd
San Jose, CA 95111
Phone (408) 817-1433

750 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-2320

751 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-5110

1993 McKee Rd
San Jose, CA 95116
Phone (408) 254-6320

660 S Fair Oaks Ave
Sunnyvale, CA 94086
Phone (408) 885-7366

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189728000000",
    "number": "1326001439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "751 S BASCOM AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282604",
            "telephone_number": "408-885-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2011 LITTLE ORCHARD ST",
            "address_2": "PUENTES CLINIC-INTERNAL MEDICINE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951251031",
            "telephone_number": "408-294-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGBUJOR",
        "first_name": "MERCY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-10",
        "last_updated": "2007-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "481610",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "481610",
            "primary": false
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "CA",
            "license": "481610",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.