Individual provider Active NPI

Terry A Flanigan, NP

  • Nurse Practitioner
  • Rancho Mirage, CA
National Provider Identifier
1790011849
Registry record updated Aug 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
NP95001378 Issued in CA
Practice address
72780 Country Club Dr
BLDG C 302
Rancho Mirage, CA 92270-4126
Phone
(760) 346-4299
Fax
(760) 776-4042
NPI assigned
Oct 26, 2009
Last updated
Aug 15, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NP95001378 CA Primary
Registered Nurse 163W00000X 399952 CA

Addresses

Primary practice location

72780 Country Club Dr
BLDG C 302
Rancho Mirage, CA 92270-4126

Mailing address

72780 Country Club Dr
BLDG C 302
Rancho Mirage, CA 92270-4126
Phone (760) 346-4299

Other identifiers 1

IdentifierTypeStateIssuer
1790011849MedicaidWI

Other names 1

  • Terry A Dragich Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
399952CAMDRegistered Nurse
NP95001378CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Eisenhower Medical Center Past Accepting new patients
John R Faulkner Medical Doctor PC Inc PastSince Apr 1, 2011 Accepting new patients
Advanced Pain Management SC Past Accepting new patients

Organizations & group practices 3

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": "1256515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471219200000",
    "number": "1790011849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72780 COUNTRY CLUB DR",
            "address_2": "BLDG C 302",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922704126",
            "telephone_number": "760-346-4299",
            "fax_number": "760-776-4042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72780 COUNTRY CLUB DR",
            "address_2": "BLDG C 302",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922704126",
            "telephone_number": "760-346-4299",
            "fax_number": "760-776-4042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLANIGAN",
        "first_name": "TERRY",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-26",
        "last_updated": "2016-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "NP95001378",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "399952",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790011849",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TERRY",
            "last_name": "DRAGICH",
            "middle_name": "A",
            "credential": "NP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Rancho Mirage, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2016; 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.