Individual provider Active NPI

Rebecca Ann Carpio-Darshay, NP

  • Family Nurse Practitioner
  • Fontana, CA
National Provider Identifier
1649459652
Registry record updated Dec 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
15350 Issued in CA
Practice address
17296 Slover Avenue
Fontana, CA 92337
Phone
(909) 609-3004
Fax
(909) 609-3045
NPI assigned
Oct 25, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X 15350 CA
Family Nurse Practitioner 363LF0000X 15350 CA Primary

Addresses

Primary practice location

17296 Slover Avenue
Fontana, CA 92337

Mailing address

17296 Slover Avenue
Fontana, CA 92337
Phone (909) 609-3004

Other identifiers 1

IdentifierTypeStateIssuer
GR0089980MedicaidCA

Other names 1

  • Mrs. Rebecca Ann Carpio Professional name

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
I20081107000499 CA Practitioner - Nurse Practitioner 4688733447 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

17296 Slover Ave
Fontana, CA 92337-7585
Phone (909) 427-5000

9961 Sierra Ave
Fontana, CA 92335-6720
Phone (909) 427-5000

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 15, 2010 Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 15, 2010 Accepting new patients

Locations

17296 Slover Ave
Fontana, CA 92337
Phone (909) 609-3000

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

393 E Walnut St
Unit 3RD
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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1193270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1649459652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17296 SLOVER AVENUE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "92337",
            "telephone_number": "909-609-3004",
            "fax_number": "909-609-3045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17296 SLOVER AVENUE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "92337",
            "telephone_number": "909-609-3004",
            "fax_number": "909-609-3045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARPIO-DARSHAY",
        "first_name": "REBECCA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-25",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "CA",
            "license": "15350",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "15350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0089980",
            "state": "CA"
        }
    ],
    "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": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "REBECCA",
            "last_name": "CARPIO",
            "middle_name": "ANN",
            "prefix": "MRS.",
            "credential": "NP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Fontana, CA

Sources for this page

Verify at the official NPI Registry.