Alexandra Lauren Pettus, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95028213 Issued in CA

Practice address

1800 Western Ave Ste 204
San Bernardino, CA 92411-1353

Phone

(909) 474-9952

NPI assigned

Mar 5, 2024

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 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

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Clinica Prenatal San Jose, Inc.

  • Obstetrics Physician
  • Santa Ana, CA
  • NPI 1508046251
  Medicare reassignment

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

{
    "created_epoch": "1709596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1750148748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "945 S RIDGECREST CIR",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928074502",
            "telephone_number": "256-620-1972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 WESTERN AVE STE 204",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924111353",
            "telephone_number": "909-474-9952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTUS",
        "first_name": "ALEXANDRA",
        "middle_name": "LAUREN",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-05",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95028213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holley Ann Peterson-Funn
• Jacquelyn Peterson, PSY.D.
• Ly Ngoc Petrie, D.D.S.
• Amanda Petros, SLP
• Georgia Pettie
• Keith Maurice Pezant
• Gregory Allen Pfau, LMFT
• Phuong-Anh Huu Pham-Stepp
• Elizabeth Pham, R.N.
• Julie T Pham, PHARMD

• Family Nurse Practitioner in San Bernardino, CA
• Providers in San Bernardino, 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 5, 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.