Individual provider Active NPI

Nicole Vidal, N.P.

  • Nurse Practitioner
  • Santa Ana, CA
National Provider Identifier
1376903724
Registry record updated Jan 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95003916 Issued in CA
Practice address
800 N Main St
Santa Ana, CA 92701-3576
Phone
(657) 282-6355
NPI assigned
Feb 28, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95003916 CA
Nurse Practitioner 363L00000X 95003916 CA Primary

Addresses

Primary practice location

800 N Main St
Santa Ana, CA 92701-3576

Mailing address

800 N Main St
Santa Ana, CA 92701-3576

Other practice location 1

1014 N Broadway
Santa Ana, CA 92701-3408
Phone (949) 270-2100

Other names 1

  • Nicole Rossi Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, SC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160427002470 CA Practitioner - Nurse Practitioner 1850690785 Reassigns benefits to 6 organizations
I20190508000759 SC Practitioner - Nurse Practitioner 1850690785 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Redondo Emergency Physicians IncGroup PAC ID 9032388269, 13 clinicians
University of California IrvineGroup PAC ID 5395658181, 57 clinicians

Practice addresses (Care Compare)

1145 W Redondo Beach Blvd
Gardena, CA 90247-3511
Phone (310) 532-4200

800 N Main St
Santa Ana, CA 92701-3576
Phone (714) 456-6324

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
95003916CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Medical Group-Midlands CurrentSince Apr 22, 2019 Accepting new patients
Share Our Selves Corporation CurrentSince Nov 30, 2020 Accepting new patients
Share Our Selves Corporation CurrentSince Nov 30, 2020 Accepting new patients
Regents of the University of CurrentSince Sep 3, 2019 Accepting new patients
Stephen R. Shea, M.D., Inc. CurrentSince Jul 1, 2017 Accepting new patients
Stephen R Shea, M.D., Inc CurrentSince Jul 1, 2017 Accepting new patients
Redondo Emergency Physicians, Inc. CurrentSince Feb 2, 2026 Accepting new patients
University of California Irvine CurrentSince Sep 3, 2019 Accepting new patients
Share Our Selves Corporation Current Accepting new patients
Reddy Urgent Care,Inc CurrentSince Nov 5, 2018 Accepting new patients
University of California Irvine CurrentSince Sep 3, 2019 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Apr 22, 2019 Accepting new patients
University of California Irvine Past Accepting new patients
University of California Irvine Past Accepting new patients

Locations

300 W Carl Karcher Way
Anaheim, CA 92801
Phone (657) 282-6356

1000 N Kraemer Pl
Anaheim, CA 92806

1550 Superior Ave
Costa Mesa, CA 92627
Phone (949) 650-0186

1145 W Redondo Beach Blvd
Gardena, CA 90247
Phone (310) 532-4200

4237 Atlantic Ave
Long Beach, CA 90807
Phone (562) 336-1656

123 Atlantic Ave
Ste B
Long Beach, CA 90802
Phone (562) 209-1569

1050 Linden Ave
Long Beach, CA 90813
Phone (562) 491-9000

27725 Santa Margarita Pkwy
Ste 101
Mission Viejo, CA 92691
Phone (949) 462-3999

101 The City Dr S
Orange, CA 92868
Phone (714) 456-6054

200 S Manchester Ave
Ste 300
Orange, CA 92868
Phone (714) 424-9001

1300 W 7th St
San Pedro, CA 90732
Phone (310) 514-5350

1014 N Broadway
Santa Ana, CA 92701
Phone (949) 270-2132

800 N Main St
Santa Ana, CA 92701
Phone (714) 456-6324

4401 W Memorial Rd
Ste 121
Oklahoma City, OK 73134
Phone (405) 749-4560

3555 Harden Street Ext
Ste 300
Columbia, SC 29203
Phone (803) 434-6411

2 Medical Park Rd
Ste 506
Columbia, SC 29203
Phone (803) 434-3930

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1456617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1376903724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 N MAIN ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927013576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 N MAIN ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927013576",
            "telephone_number": "657-282-6355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1014 N Broadway",
            "address_purpose": "LOCATION",
            "city": "Santa Ana",
            "state": "CA",
            "postal_code": "927013408",
            "country_code": "US",
            "telephone_number": "949-270-2100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VIDAL",
        "first_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-28",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95003916",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95003916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "ROSSI",
            "credential": "N.P.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Santa Ana, CA

Sources for this page

Verify at the official NPI Registry.