Individual provider Active NPI

Antonio S Molina McBride, FAMILY NP

  • Family Nurse Practitioner
  • Pasadena, CA
National Provider Identifier
1548884208
Registry record updated Mar 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95014571 Issued in CA
Practice address
393 E Walnut St
Pasadena, CA 91188-3197
Phone
(800) 464-4000
NPI assigned
May 29, 2020
Last updated
Mar 15, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2022

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 95014571 CA Primary

Addresses

Primary practice location

393 E Walnut St
Pasadena, CA 91188-3197

Mailing address

393 E Walnut St
Pasadena, CA 91188-3197
Phone (626) 710-5056

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20220328002360 CA Practitioner - Nurse Practitioner 4082009154 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Dec 10, 2021 Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 10, 2021 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

4733 W Sunset Blvd
Los Angeles, CA 90027
Phone (213) 667-4784

4760 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 783-0567

393 E Walnut St
Pasadena, CA 91188
Phone (626) 405-7914

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

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

NPI Registry JSON

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

{
    "created_epoch": "1590710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647302400000",
    "number": "1548884208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 E WALNUT ST",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911883197",
            "telephone_number": "626-710-5056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "393 E WALNUT ST",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911883197",
            "telephone_number": "800-464-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCBRIDE",
        "first_name": "ANTONIO",
        "middle_name": "S MOLINA",
        "name_prefix": "Mr.",
        "credential": "FAMILY NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-29",
        "last_updated": "2022-03-15",
        "certification_date": "2020-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95014571",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4733 W Sunset Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900276021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

Verify at the official NPI Registry.