Laurensia Hermy Widyastami, AGNP-BC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95007344 Issued in CA

Practice address

450 Stanyan St
San Francisco, CA 94117-1019

Phone

(415) 680-4135

NPI assigned

Oct 5, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

90

Promoting interoperability

100

Improvement activities

40

Cost

78.43

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lwidyastami341490@hisp.ehr.sutterhealth.org

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.

• Pacific Inpatient Medical Group

  • Internal Medicine Physician
  • San Francisco, CA
  • NPI 1447447248
  Medicare reassignment NPD

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

{
    "created_epoch": "1507161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507161600000",
    "number": "1427568351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61A SUSSEX ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941313011",
            "telephone_number": "626-232-1421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 STANYAN ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941171019",
            "telephone_number": "415-680-4135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDYASTAMI",
        "first_name": "LAURENSIA",
        "middle_name": "HERMY",
        "credential": "AGNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-05",
        "last_updated": "2017-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95007344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Induni Asoka Wickramasinghe
• Tinisha Wicks
• Michael Christian Resayo Wico
• Cheryl A Widdis, DDS
• Eric Walter Widera, M.D.
• Lou Ann Wieand, PH.D.
• Katherine Wiebe, PH.D.
• Eckehart Wiedemann, M.D.
• Neil Wiegand, PA-C
• Sarah Elizabeth Wiegand, DPT/PT

• Nurse Practitioner in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.