Regina Marie Formentin, NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

254655 Issued in AZ

Practice address

6242 E Arbor Ave Ste 111
Mesa, AZ 85206-1309

Phone

(602) 755-0800

Fax

(602) 560-2721

NPI assigned

Feb 25, 2021

Last updated

Aug 27, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Summit Medical Group Arizona LLCGroup PAC ID 3173872835, 152 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Banner Home Care-Arizona Home health agency, Mesa, AZ, CCN 037015
• Integrity Home Health Care Services, LLC Home health agency, Phoenix, AZ, CCN 037246
• American Home Health Services, Inc. Home health agency, Mesa, AZ, CCN 037426
• Banner Baywood Medical Center Hospital, Mesa, AZ, CCN 030088

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: regina.formentin.1@19654.direct.athenahealth.com

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.

• Summit Medical Group Arizona LLC

  • Family Medicine Physician
  • Glendale, AZ
  • NPI 1053810622
  Medicare reassignment Care Compare group NPD
• Pophealthcare Medical Services of Az, PC

  • Nurse Practitioner
  • Tempe, AZ
  • NPI 1760884175
  Medicare reassignment NPD
• Pophealthcare Medical Services of Az, PC

  • Family Nurse Practitioner
  • Tempe, AZ
  • NPI 1417652454
  NPD
• Newco Hatfield Medical Group PLLC

  • Family Medicine Physician
  • Chandler, AZ
  • NPI 1578125233
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• American Home Health Services, Inc

  • Home Health Agency
  • Mesa, AZ
  • NPI 1114279536
  Care Compare affiliation
• Banner Baywood Medical Center

  • General Acute Care Hospital
  • Mesa, AZ
  • NPI 1194758284
  Care Compare affiliation
• Banner Home Care-Arizona

  • Home Health Agency
  • Sun City, AZ
  • NPI 1023051927
  Care Compare affiliation
• Integrity Home Health Care Services, LLC

  • Home Health Agency
  • Phoenix, AZ
  • NPI 1336246990
  Care Compare affiliation

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

{
    "created_epoch": "1614211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1700470275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11500 E COCHISE DR UNIT 2104",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852594931",
            "telephone_number": "734-309-9908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6242 E ARBOR AVE STE 111",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061309",
            "telephone_number": "602-755-0800",
            "fax_number": "602-560-2721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMENTIN",
        "first_name": "REGINA",
        "middle_name": "MARIE",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-25",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "254655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Michael Fordell, P.A.
• Eddie Franklin Forehand, FNP
• Foreign Language Service Corp (A Foreign Language Service)
• Forever Loved Home Health Care
• Andrew E Forman, DDS, MS
• Stephanie Fornaciari, ABA
• Sherry Lynn Forsyth Carter, MC, LPC
• Kathryn M Forsyth, L.P.C.
• Forte - Phoenix, PLLC (Forte)
• Christine Forti

• Nurse Practitioner in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.