Jennifer Kaori Fukasawa-Lara, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA54259 Issued in CA

Practice address

600 N Highland Springs Ave
Banning, CA 92220-3046

Phone

(951) 845-1121

NPI assigned

Mar 6, 2017

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

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

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Carbon Health Medical Group of California PCGroup PAC ID 9032340047, 335 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Carbon Health Medical Group of California PC

  • Urgent Care Clinic/Center
  • Berkeley, CA
  • NPI 1417294232
  Medicare reassignment Care Compare group
• Southern California Emergency Medicine

  • Urgent Care Clinic/Center
  • San Bernardino, CA
  • NPI 1639314255
  Medicare reassignment
• Southern California Emergency Medicine

  • Urgent Care Clinic/Center
  • Riverside, CA
  • NPI 1063191575
  NPD
• Southern California Emergency Medicine

  • Urgent Care Clinic/Center
  • Redlands, CA
  • NPI 1457888034
  NPD
• Carbon Health Primary Care of California PC

  • Multi-Specialty Clinic/Center
  • Berkeley, CA
  • NPI 1972057990
  NPD (past)
• Premier Emergency Physicians of California Medical Group PC

  • Emergency Medicine Physician
  • Barstow, CA
  • NPI 1225289135

  Physician Assistant

  NPD (past)
• Rainbow Basin Emergency Physicians, a Medical Corporation

  • Emergency Medicine Physician
  • Barstow, CA
  • NPI 1811148729

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1488758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605139200000",
    "number": "1477093714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38905 VISTA DR",
            "city": "CATHEDRAL CITY",
            "state": "CA",
            "postal_code": "922342156",
            "telephone_number": "310-408-9476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 N HIGHLAND SPRINGS AVE",
            "city": "BANNING",
            "state": "CA",
            "postal_code": "922203046",
            "telephone_number": "951-845-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUKASAWA-LARA",
        "first_name": "JENNIFER",
        "middle_name": "KAORI",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-06",
        "last_updated": "2020-11-12",
        "certification_date": "2020-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA54259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• First Americans Medical Group, Inc.
• FJS Hearing Professionals
• Evelyn Flores
• Mireya Flores
• Mark Steven Foster, M.D
• Crystal Gallardo
• Lenore Gamez
• Tania Guadalupe Garcia Avalos
• Karen Lizeth Garcia, CATC
• Regina Francine Garner, LMT, AS

• Physician Assistant in Banning, CA
• Providers in Banning, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2020; 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.