Individual provider Active NPI

Demetrius McClinton Washington, FNP

  • Family Nurse Practitioner
  • Anaheim, CA
National Provider Identifier
1508124116
Registry record updated Aug 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
21078 Issued in CA
Practice address
1155 S Summer Breeze LN
Anaheim, CA 92808-2529
Phone
(714) 271-9843
NPI assigned
May 2, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 21078 CA Primary

Addresses

Primary practice location

1155 S Summer Breeze LN
Anaheim, CA 92808-2529

Mailing address

3440 Hollywood Blvd
Suite 460
Hollywood, FL 33021-6927
Phone (714) 271-9843

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
I20160205001887 CA Practitioner - Nurse Practitioner 8820392194 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of Los AngelesGroup PAC ID 1850296534, 395 clinicians

Practice addresses (Care Compare)

245 S Fetterly Ave
Los Angeles, CA 90022-1605
Phone (323) 780-2216

Hospital & facility affiliations

  • Los Angeles General Medical Center Hospital, Los Angeles, CA, CCN 050373

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles CurrentSince Jan 2, 2016 Accepting new patients
County of Los Angeles CurrentSince Jan 2, 2016 Accepting new patients
County of Los Angeles Current Accepting new patients

Locations

1000 S Fremont Ave
Unit 9
Alhambra, CA 91803

245 S Fetterly Ave
Los Angeles, CA 90022
Phone (323) 362-1010

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1335916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597881600000",
    "number": "1508124116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3440 HOLLYWOOD BLVD",
            "address_2": "SUITE 460",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330216927",
            "telephone_number": "714-271-9843",
            "fax_number": "186-698-6226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 S SUMMER BREEZE LN",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928082529",
            "telephone_number": "714-271-9843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASHINGTON",
        "first_name": "DEMETRIUS",
        "middle_name": "MCCLINTON",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-02",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "21078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.