Individual provider Active NPI

Media R Mupanduki

  • Psychiatric/Mental Health Nurse Practitioner
  • Long Beach, CA
National Provider Identifier
1598232928
Registry record updated Apr 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95016352 Issued in CA
Practice address
1501 Hughes Way Ste 150
Long Beach, CA 90810-1878
Phone
(310) 221-6336
NPI assigned
Oct 24, 2018
Last updated
Apr 1, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X AP139444 TX
Primary Care Nurse Practitioner 363LP2300X 95016352 CA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95016352 CA Primary

Addresses

Primary practice location

1501 Hughes Way Ste 150
Long Beach, CA 90810-1878

Mailing address

1501 Hughes Way Ste 150
Long Beach, CA 90810-1878
Phone (310) 221-6336

Other identifiers 1

IdentifierTypeStateIssuer
AP139444OtherTXFAMILY NURSE PRACTITIONER

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
I20220930001140 CA Practitioner - Nurse Practitioner 9234463720 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP139444TXMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians Urgent Care Inc. CurrentSince Mar 5, 2024 Accepting new patients
Emergency Physicians Urgent Care Inc. CurrentSince Mar 5, 2024 Accepting new patients

Locations

212 Coffee Rd
Bakersfield, CA 93309
Phone (661) 829-6937

212 Coffee Rd
Ste 100
Bakersfield, CA 93309
Phone (661) 885-6060

9710 Brimhall Rd
Bakersfield, CA 93312
Phone (661) 331-8640

4108 Edison Ave
Ste 112
Chino, CA 91710
Phone (909) 334-4545

32860 Pacific Coast Hwy
Ste 24
Dana Point, CA 92629
Phone (949) 441-2922

6789 N Blackstone Ave
Fresno, CA 93710
Phone (559) 512-3377

41540 Winchester Rd
Temecula, CA 92590
Phone (951) 365-5585

Interoperability endpoints

  • Direct secure messaging: mmupanduki586146@direct.llu.edu

Organizations & group practices 2

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": "1540339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648771200000",
    "number": "1598232928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 HUGHES WAY STE 150",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908101878",
            "telephone_number": "310-221-6336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 HUGHES WAY STE 150",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908101878",
            "telephone_number": "310-221-6336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUPANDUKI",
        "first_name": "MEDIA",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-24",
        "last_updated": "2022-04-01",
        "certification_date": "2022-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "TX",
            "license": "AP139444",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "95016352",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95016352",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY NURSE PRACTITIONER",
            "identifier": "AP139444",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.