Jason Grant Quallich, ARNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95023490 Issued in CA

Practice address

3841 Brickway Blvd
Santa Rosa, CA 95403-8226

Phone

(727) 515-9490

NPI assigned

Apr 27, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Mobile Visiting Practitioners, LLC

  • Primary Care Nurse Practitioner
  • Daytona Beach, FL
  • NPI 1265915359
  Medicare reassignment NPD
• Behavioral Health Services of Florida LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Daytona Beach, FL
  • NPI 1619649217
  NPD

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

{
    "created_epoch": "1303862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675209600000",
    "number": "1427349380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3654 ALTA VISTA AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954094049",
            "telephone_number": "727-515-9490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3841 BRICKWAY BLVD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954038226",
            "telephone_number": "727-515-9490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUALLICH",
        "first_name": "JASON",
        "middle_name": "GRANT",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-27",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9229231",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95023490",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003541900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Q Care Plus Medical California, PC
• Naser Mansour Qabazard, PHARM.D.
• Emily Qirreh, MFT TRAINEE
• Cassie Qiu
• Nhung Thanh Quach, MD
• Lorrie Quam, LCSW
• Christopher Quan, MD
• Elisa Margarita Quan, D.O.
• Winchell Quan
• Linda Huong Quang, PHARM.D

• Family Nurse Practitioner in Santa Rosa, CA
• Providers in Santa Rosa, 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 Feb 1, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.