Holly Diane Fyda, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP95011339 Issued in CA

Practice address

2159 Castle Rock Cir
Corona, CA 92878-5465

Phone

(951) 285-5571

NPI assigned

Apr 10, 2019

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

Other identifiers 1

Other names 1

• Holly Diane Gannon Former name

Electronic endpoints 1

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, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern California Permanente Medical Group 11,250 clinicians

Cep America - Neurology PC 60 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Corona Regional Medical Center Hospital, Corona, CA, CCN 050329

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: hfyda41714@altamed.direct-ci.com

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.

• Cep America - Neurology PC

  • Neurology Physician
  • Santa Barbara, CA
  • NPI 1225569346

  CA

  Medicare reassignment Care Compare group NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Riverside, CA
  • NPI 1316979834

  CA

  Medicare reassignment Care Compare group NPD
• Cep America - Neurology PC

  • Neurology Physician
  • Terre Haute, IN
  • NPI 1124843586
  Care Compare group NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280
  Care Compare group
• Southern California Permanente Medical Group

  • Clinical Medical Laboratory
  • N Hollywood, CA
  • NPI 1891873303
  Care Compare group
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Woodland Hills, CA
  • NPI 1952333478
  Care Compare group
• Cep America - Neurology PC

  • Neurology Physician
  • Saint Johns, FL
  • NPI 1164109328
  Care Compare group
• Cep America - Neurology PC

  • Neurology Physician
  • Terre Haute, IN
  • NPI 1174132708
  Care Compare group
• Cep America - Neurology PC

  • Neurology Physician
  • Clinton, IN
  • NPI 1639788250
  Care Compare group
• Cep America - Neurology PC

  • Psychiatry Physician
  • Silverdale, WA
  • NPI 1669223830
  Care Compare group
• Cep America - Neurology PC

  • Neurology Physician
  • Murrieta, CA
  • NPI 1235779521
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD

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

• Uhs-Corona Inc

  • General Acute Care Hospital
  • Corona, CA
  • NPI 1457347239

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1554854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1750844304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2159 CASTLE ROCK CIR",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928785465",
            "telephone_number": "951-285-5571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2159 CASTLE ROCK CIR",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928785465",
            "telephone_number": "951-285-5571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FYDA",
        "first_name": "HOLLY",
        "middle_name": "DIANE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-10",
        "last_updated": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95011339",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BRN",
            "identifier": "NP95011339",
            "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": "10800 Magnolia Ave",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925053043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "HOLLY",
            "last_name": "GANNON",
            "middle_name": "DIANE",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David Fukuchi
• Dante Vincent Fulgenzi, DPT
• Fullerton Health Inc
• Fullerton Pharmacy, Inc.
• Navid Parviz Furutan, MD
• Kathryn Ellorin Gabot-Puhawan, M.D.
• Naomi Mikiko Gabot, R.N.
• Gabriela Care Home, Inc.
• Maria Teresa Gabutina
• Patrick Muraguri Gachima, O.T.

• All providers in Corona, CA
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 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.