Gilbert Agyemang-Boakye
Individual provider Active NPI Family Nurse Practitioner · Yucaipa, CA
NPI 1407385149 · NPPES record last updated Apr 16, 2024
Key facts
- NPI
- 1407385149
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 95004250 (CA)
- Practice address
- 11711 Sand Canyon Rd
Yucaipa, CA 92399-1742 - Phone
- (909) 389-3272
- NPI assigned
- Jun 7, 2017
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Jandp Spine Center Inc.
Practice addresses (Care Compare)
6079 N Fresno St
Suite 101
Fresno, CA 93710-5276
Phone (553) 538-3145
Hospital & facility affiliations
- Prohealth Home Care, Inc
- Community Regional Medical Center
- Clovis Community Medical Center
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: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240430002336 | CA | Practitioner - Nurse Practitioner | 3476993080 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| J&P Spine Center Inc | Current |
Accepting new patients | |
| J&P Spine Center Inc. | Current |
Accepting new patients |
Locations
7050 N Recreation Ave
Ste 101
Fresno, CA 93720
Phone (559) 325-3515
6079 N Fresno St
Ste 101
Fresno, CA 93710
Phone (553) 538-3145
1332 W Herndon Ave
Ste 102
Fresno, CA 93711
Phone (559) 440-9640
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 95004250 | CA | Yes |
Addresses
Primary practice location
11711 Sand Canyon Rd
Yucaipa, CA 92399-1742
Mailing address
25590 Prospect Ave Apt 42F
Loma Linda, CA 92354-3155
Phone (951) 534-7114
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 95004250 | Other | CA | BRN |
Other providers in Yucaipa, CA
- James R. Adams IV
- Abena Nyarko Adom
- Advanced Wellness Physical Therapy, PC
- Dennis James Agudo Jr.
- Richard Aguirre
- Sara Al Tally
- Madisyn Albanese
- Daniela Alcayde-Sprenkle
- Chantale Aleman
- Veronica Ann Sayre Alinsug
All providers in Yucaipa, CA · Family Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2024. 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.