Individual provider Active NPI

Anthony Ambrosino, P.A.

  • Physician Assistant
  • Antioch, CA
National Provider Identifier
1558733451
Registry record updated Aug 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2904 Carolyn CT
Antioch, CA 94509-4952
Phone
(925) 628-7627
NPI assigned
Oct 30, 2015
Last updated
Aug 26, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

2904 Carolyn CT
Antioch, CA 94509-4952

Mailing address

3901 Lone Tree Way
Antioch, CA 94509-6200
Phone (925) 628-7267

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
I20160211002551 CA Practitioner - Physician Assistant 8022312024 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eric L Ellis MD IncGroup PAC ID 9032458815, 17 clinicians

Practice addresses (Care Compare)

5290 Douglas Blvd
Granite Bay, CA 95746-6205
Phone (916) 258-2751

77 Lincoln Blvd
Suite 1
Lincoln, CA 95648-7422
Phone (916) 258-2751

Merit-based Incentive Payment System (MIPS)

Final score
88.38 of 100Reported as group
Quality
77.6
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
53115CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America-California CurrentSince Feb 1, 2016 Accepting new patients
Cep America - California CurrentSince Feb 1, 2016 Accepting new patients
Sutter North Medical Foundation Past Accepting new patients

Locations

3901 Lone Tree Way
Antioch, CA 94509
Phone (925) 779-7200

1205 E North St
Manteca, CA 95336
Phone (209) 239-8301

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 900-3125

4445 Magnolia Ave
Riverside, CA 92501
Phone (800) 498-7156

Interoperability endpoints

  • Direct secure messaging: anthony.ambrosino.1@19336.direct.athenahealth.com
  • Direct secure messaging: anthony.ambrosino.1@2545.direct.athenahealth.com

Organizations & group practices 7

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": "1446163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472169600000",
    "number": "1558733451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 LONE TREE WAY",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945096200",
            "telephone_number": "925-628-7267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2904 CAROLYN CT",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945094952",
            "telephone_number": "925-628-7627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMBROSINO",
        "first_name": "ANTHONY",
        "credential": "P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-10-30",
        "last_updated": "2016-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Antioch, CA

Sources for this page

Verify at the official NPI Registry.