Gracielle Mae Ejanda Advincula, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95018873 Issued in CA

Practice address

1306 Broadway
El Cajon, CA 92021-5810

Phone

(619) 551-7400

NPI assigned

Nov 8, 2021

Last updated

Nov 8, 2021By 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

Other identifiers 1

Electronic endpoints 1

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, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

• Centro de Salud de la Comunidad de San Ysidro, Inc.

  dba San Ysidro Health Precision Park

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1124782685
  Medicare reassignment
• Centro de Salud de la Comunidad de San Ysidro Inc

  dba San Ysidro Health Senior Dental Center

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1457033813
  NPD
• Centro de Salud de la Comunidad de San Ysidro, Inc

  dba San Ysidro Health Urgent Care

  • Federally Qualified Health Center (FQHC)
  • Chula Vista, CA
  • NPI 1366053167
  NPD

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

{
    "created_epoch": "1636329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636329600000",
    "number": "1376208975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2177 DIAMONDBACK CT UNIT 21",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919152900",
            "telephone_number": "909-231-4348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 BROADWAY",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920215810",
            "telephone_number": "619-551-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADVINCULA",
        "first_name": "GRACIELLE MAE",
        "middle_name": "EJANDA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-08",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95018873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NP STATE LICENSE",
            "identifier": "95018873",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gadvincula@stpaulspace.org",
            "affiliation": "N",
            "address_1": "1306 Broadway",
            "city": "El Cajon",
            "state": "CA",
            "country_code": "US",
            "postal_code": "920215810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Family Nurse Practitioner in El Cajon, CA
• Providers in El Cajon, 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 Nov 8, 2021; 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.