Individual provider Active NPI

Rafael Roman Teran, F.N.P.

  • Family Nurse Practitioner
  • Fresno, CA
National Provider Identifier
1487939989
Registry record updated Feb 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP20891 Issued in CA
Practice address
2576 S Duke Ave
Fresno, CA 93727-8831
Phone
(559) 123-4567
NPI assigned
Oct 15, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X 20891 CA
Family Health Clinical Nurse Specialist 364SF0001X 20891 CA
Family Nurse Practitioner 363LF0000X NP20891 CA Primary

Addresses

Primary practice location

2576 S Duke Ave
Fresno, CA 93727-8831

Mailing address

2576 S Duke Ave
Fresno, CA 93727-8831

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20120612000552 CA Practitioner - Nurse Practitioner 6800050345 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP20891CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
County of Fresno CurrentSince Feb 2, 2016 Accepting new patients
County of Fresno CurrentSince Feb 2, 2016 Accepting new patients
Long Term Care Medical Group, Inc CurrentSince Oct 4, 2014 Accepting new patients
Regenerative Spine, Pain, and Neuropathy Centers, Inc. PastSince Jun 22, 2021 Accepting new patients
Lags Spine and Sportscare Medical Centers, Inc. Past Accepting new patients

Locations

925 N Cornelia Ave
Fresno, CA 93706
Phone (559) 275-4785

685 W Alluvial Ave
Ste 103
Fresno, CA 93711
Phone (559) 274-6444

4441 E Kings Canyon Rd
Fresno, CA 93702
Phone (559) 453-4099

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1318636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424908800000",
    "number": "1487939989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2576 S DUKE AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937278831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2576 S DUKE AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937278831",
            "telephone_number": "559-123-4567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERAN",
        "first_name": "RAFAEL",
        "middle_name": "ROMAN",
        "credential": "F.N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-15",
        "last_updated": "2015-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "CA",
            "license": "20891",
            "primary": false
        },
        {
            "code": "364SF0001X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": "CA",
            "license": "20891",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP20891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.