NPIMap

Individual provider Active NPI

Daniel Hestehauge, P.A

  • Physician Assistant
  • Rancho Cucamonga, CA
National Provider Identifier
1427485762
Registry record updated Oct 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA23257 Issued in CA
Practice address
9089 Baseline Rd
Suite 100
Rancho Cucamonga, CA 91730-1295
Phone
(909) 483-0505
Fax
(909) 483-0508
NPI assigned
Oct 1, 2013
Last updated
Oct 1, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA23257 CA Primary

Addresses

Primary practice location

9089 Baseline Rd
Suite 100
Rancho Cucamonga, CA 91730-1295

Mailing address

9089 Baseline Rd
Suite 100
Rancho Cucamonga, CA 91730-1295
Phone (909) 483-0505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140225002269 CA Practitioner - Physician Assistant 2668602301 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Family and Industrial Medical Center IncGroup PAC ID 1759318256, 9 clinicians

Practice addresses (Care Compare)

47 Santa Rosa St
San Luis Obispo, CA 93405-1811
Phone (805) 542-9596

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.2 of 100Reported as individual
Quality
86.36
Promoting interoperability
96
Improvement activities
40
Cost
74.31

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA23257CAMDPhysician Assistant

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: daniel.hestehauge.1@13850.direct.athenahealth.com

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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": "1380585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380585600000",
    "number": "1427485762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9089 BASELINE RD",
            "address_2": "SUITE 100",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917301295",
            "telephone_number": "909-483-0505",
            "fax_number": "909-483-0508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9089 BASELINE RD",
            "address_2": "SUITE 100",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917301295",
            "telephone_number": "909-483-0505",
            "fax_number": "909-483-0508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HESTEHAUGE",
        "first_name": "DANIEL",
        "credential": "P.A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-10-01",
        "last_updated": "2013-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA23257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

Verify at the official NPI Registry.