Shelly Rebecca Lummus, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

417062 Issued in CA

Practice address

3505 Cadillac Ave
Building O Suite 110
Costa Mesa, CA 92626-1429

Phone

(714) 755-1160

NPI assigned

Jun 13, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Bristol Park Medical Group, Inc

  • Family Medicine Physician
  • Costa Mesa, CA
  • NPI 1043266760
  NPD (past)

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1649474545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5225 TEDFORD WAY",
            "city": "YORBA LINDA",
            "state": "CA",
            "postal_code": "928864122",
            "telephone_number": "714-331-2034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 CADILLAC AVE",
            "address_2": "BUILDING O SUITE 110",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926261429",
            "telephone_number": "714-755-1160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUMMUS",
        "first_name": "SHELLY",
        "middle_name": "REBECCA",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-13",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "417062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTITIONER CERTIF",
            "identifier": "9198",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTERD NURSE NUMBER",
            "identifier": "RN 417062",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lukas Chiropractic, Inc.
• Shelby Nicole Lukason
• Sarah Lukehart
• Vanessa Lumactod
• Cassandra Lumbang
• Jessica Luna Benitez
• Luna Rose Behavioral Health Inc.
• Erin Luna
• Sarah Maureen Luna
• Vivianna Luna

• Family Nurse Practitioner in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.