Individual provider Active NPI

Bernadette Lopez, FNP-BC

  • Nurse Practitioner
  • Elk Grove, CA
National Provider Identifier
1609668342
Registry record updated May 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95034994 Issued in CA
Practice address
9629 Philta Way
Elk Grove, CA 95757-6201
Phone
(661) 330-9429
NPI assigned
May 19, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 95034994 CA Primary

Addresses

Primary practice location

9629 Philta Way
Elk Grove, CA 95757-6201

Mailing address

9629 Philta Way
Elk Grove, CA 95757-6201
Phone (661) 330-9429

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
I20251114001163 CA Practitioner - Nurse Practitioner 9335630623 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Advance Nursing Practice Medical Group IncGroup PAC ID 5597191494, 4 clinicians

Practice addresses (Care Compare)

809 Sylvan Ave
Suite 400
Modesto, CA 95350-1500
Phone (209) 567-2576

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
95034994CAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Advance Nursing Practice Medical Group Inc CurrentSince Sep 1, 2025 Accepting new patients

Locations

809 Sylvan Ave
Ste 400
Modesto, CA 95350
Phone (209) 529-4422

Organizations & group practices 1

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": "1747612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747612800000",
    "number": "1609668342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9629 PHILTA WAY",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957576201",
            "telephone_number": "661-330-9429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9629 PHILTA WAY",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957576201",
            "telephone_number": "661-330-9429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "BERNADETTE",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-05-19",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95034994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk Grove, CA

Sources for this page

Verify at the official NPI Registry.