Brenda Smith, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209011357 041325955 Issued in IL

Practice address

918 W Foothill Blvd
Upland, CA 91786-3772

Phone

(909) 890-5511

NPI assigned

Apr 1, 2014

Last updated

Nov 15, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA, IL, MS3 enrollments

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 3

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Central Health Plan of California, Inc.

  • Health Maintenance Organization
  • Diamond Bar, CA
  • NPI 1386714772
  Medicare reassignment NPD
• Molina Healthcare of California

  dba Molina Medical Centers

  • Health Maintenance Organization
  • Long Beach, CA
  • NPI 1194811760
  Medicare reassignment NPD
• Mazen Abdel-Hadi, M.D., L.L.C.

  • Pulmonary Disease Physician
  • Burr Ridge, IL
  • NPI 1083273080
  Medicare reassignment NPD
• Molina Care Connections, LLC.

  dba Molina CC

  • Nurse Practitioner
  • Long Beach, CA
  • NPI 1407243223

  MS

  Medicare reassignment
• Universal Care

  • Pediatrics Physician
  • Long Beach, CA
  • NPI 1376632877
  NPD

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

{
    "created_epoch": "1396310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700006400000",
    "number": "1447678081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 E KATELLA AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928056614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "918 W FOOTHILL BLVD",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917863772",
            "telephone_number": "909-890-5511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "BRENDA",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-01",
        "last_updated": "2023-11-15",
        "certification_date": "2022-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209011357 041325955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "brenda.smith@pposbc.org",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Only for HIE",
            "address_1": "918 W Foothill Blvd",
            "city": "Upland",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917863772",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Pamela Slocum
• Victoria Smalley
• Smile Studio
• Smileneeds Dental
• Anthony W Smith
• Claire Smith
• Jamie Roshonnda Smith
• Jason M Smith, P.T.
• Jennifer Lynn Smith
• Ryan Gregory Smith, MD

• Family Nurse Practitioner in Upland, CA
• Providers in Upland, 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 Nov 15, 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.