Individual provider Active NPI

Beatrice Ihegharauche Okonkwo

  • Psychiatric/Mental Health Nurse Practitioner
  • Chino, CA
National Provider Identifier
1558019984
Registry record updated Mar 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95020298 Issued in CA
Practice address
12555 Central Ave Ste C
Chino, CA 91710-3569
Phone
(909) 902-1082
Fax
(909) 628-3983
NPI assigned
Mar 15, 2022
Sex
Female
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
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95020298 CA Primary

Addresses

Primary practice location

12555 Central Ave Ste C
Chino, CA 91710-3569

Mailing address

12555 Central Ave Ste C
Chino, CA 91710-3569
Phone (909) 902-1082

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
I20220518001502 CA Practitioner - Nurse Practitioner 9234516998 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

12555 Central Ave
Suite C
Chino, CA 91710-3569
Phone (909) 902-1082

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
95020298CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Inland Psychiatric Medical Group, Inc. Psychiatric/Mental Health CurrentSince Apr 21, 2022 Accepting new patients
Inland Psychiatric Medical Group, Inc. Psychiatric/Mental Health CurrentSince Apr 21, 2022 Accepting new patients
Inland Psychiatric Medical Group, Inc. Psychiatric/Mental Health Current Accepting new patients
Dignity Health Past Accepting new patients
Pomona Valley Hospital Medical Center Past Accepting new patients

Locations

5475 Walnut Ave
Chino, CA 91710
Phone (909) 591-6446

12555 Central Ave
Ste C
Chino, CA 91710
Phone (909) 613-0100

500 W Badillo St
Covina, CA 91722
Phone (626) 859-2686

1620 S Grand Ave
Glendora, CA 91740
Phone (626) 335-1919

1656 W Avenue J
Lancaster, CA 93534
Phone (661) 942-1169

23110 Atlantic Cir
Ste F
Moreno Valley, CA 92553
Phone (951) 243-6455

8710 Monroe Ct
Ste 150
Rancho Cucamonga, CA 91730
Phone (909) 941-4870

1809 W Redlands Blvd
Redlands, CA 92373
Phone (909) 307-1320

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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": "1647302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647302400000",
    "number": "1558019984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12555 CENTRAL AVE STE C",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917103569",
            "telephone_number": "909-902-1082",
            "fax_number": "909-628-3983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12555 CENTRAL AVE STE C",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917103569",
            "telephone_number": "909-902-1082",
            "fax_number": "909-628-3983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKONKWO",
        "first_name": "BEATRICE",
        "middle_name": "IHEGHARAUCHE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-15",
        "last_updated": "2022-03-15",
        "certification_date": "2022-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95020298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chino, CA

Sources for this page

Verify at the official NPI Registry.