Individual provider Active NPI

Ann Sherly Varghese, A-GNP-C

  • Nurse Practitioner
  • San Bernardino, CA
National Provider Identifier
1700240629
Registry record updated Jul 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95004028 Issued in CA
Practice address
401 E Highland Ave
Suite No. 551
San Bernardino, CA 92404-3803
Phone
(909) 475-0935
NPI assigned
Apr 6, 2016
Last updated
Jul 23, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2020

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 95004028 CA Primary

Addresses

Primary practice location

401 E Highland Ave
Suite No. 551
San Bernardino, CA 92404-3803

Mailing address

1553 W Ceres St
Rialto, CA 92376-6279
Phone (909) 215-0803

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
I20161011000816 CA Practitioner - Nurse Practitioner 2466740238 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nephrology Associates Medical Group IncGroup PAC ID 5092604447, 64 clinicians

Practice addresses (Care Compare)

401 E Highland Ave
Suite 551
San Bernardino, CA 92404-3840
Phone (909) 882-9150

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
95004028CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Nephrology Associates Medical Group Inc CurrentSince Aug 15, 2016 Accepting new patients
Riverside Healthcare System, L.P. Past Accepting new patients
Cedars-Sinai Medical Center Past Accepting new patients
Community Hospital of San Bernardino Past Accepting new patients

Locations

7223 Church St
Ste A20
Highland, CA 92346
Phone (909) 381-3900

3660 Park Sierra Dr
Ste 203
Riverside, CA 92505
Phone (951) 687-3400

3660 Park Sierra Dr
Ste 208
Riverside, CA 92505
Phone (951) 687-2800

401 E Highland Ave
Ste 551
Sn Bernrdno, CA 92404
Phone (909) 882-1759

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

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": "1459900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595462400000",
    "number": "1700240629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1553 W CERES ST",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923766279",
            "telephone_number": "909-215-0803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E HIGHLAND AVE",
            "address_2": "SUITE NO. 551",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924043803",
            "telephone_number": "909-475-0935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VARGHESE",
        "first_name": "ANN SHERLY",
        "credential": "A-GNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-06",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95004028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.