Nina Nicole Bowman, D.O.
Individual provider Active NPI Surgery Physician · Colton, CA
NPI 1386806883 · NPPES record last updated Nov 4, 2021
Key facts
- NPI
- 1386806883
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 20A10250 (CA)
- Practice address
- 400 N Pepper Ave
Colton, CA 92324-1801 - Phone
- (909) 580-6222
- Fax
- (909) 580-1363
- NPI assigned
- Jun 26, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- General Surgery
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southern California Permanente Medical Group
Practice addresses (Care Compare)
2295 S Vineyard Ave
Ontario, CA 91761-7925
Phone (909) 724-5000
9961 Sierra Ave
Fontana, CA 92335-6720
Phone (909) 427-5000
Hospital & facility affiliations
- Kaiser Foundation Hospital Fontana/Ontario
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111012000202 | CA | Practitioner - General Surgery |
5698947869 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A10250 | CA | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current | Accepting new patients |
Locations
9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910
393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 20A10250 | CA | Yes |
Addresses
Primary practice location
400 N Pepper Ave
Colton, CA 92324-1801
Mailing address
36 Edgebrook Dr
Pomona, CA 91766-4768
Phone (909) 622-1319
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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 |
Other providers in Colton, CA
- Mayra Bosch
- Emad Botros
- Botrosons Pharmaceutical Inc
- Zayne Edward Boudreauxramirez
- Katherine Elizabeth Bourbeau-Medinilla
- Farshid Bozorgnia
- Andreniki Bradbury
- Braincom Advanced Nursing Corporation
- Brainiac Medical Corporation
- Brandon J Inc
All providers in Colton, CA · Surgery Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.