NPIMap

Individual provider Active NPI

Linda Susan Nugen, L.C.S.W.

  • Clinical Social Worker
  • Fontana, CA
National Provider Identifier
1801039532
Registry record updated Nov 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCS15266 Issued in CA
Practice address
17046 Marygold Ave
Fontana, CA 92335-1722
Phone
(909) 427-5128
Fax
(909) 427-6268
NPI assigned
Apr 10, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCS15266 CA Primary

Addresses

Primary practice location

17046 Marygold Ave
Fontana, CA 92335-1722

Mailing address

17046 Marygold Ave
Fontana, CA 92335-1722
Phone (909) 427-5128

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL http://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysymc.svc/scalceg Health Information Exchange (HIE) Southern California Permanente Medical Group

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

State licenses

LicenseStateTypeSpecialty
LCS15266CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Hospitals Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1239321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638057600000",
    "number": "1801039532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17046 MARYGOLD AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923351722",
            "telephone_number": "909-427-5128",
            "fax_number": "909-427-6268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17046 MARYGOLD AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923351722",
            "telephone_number": "909-427-5128",
            "fax_number": "909-427-6268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NUGEN",
        "first_name": "LINDA",
        "middle_name": "SUSAN",
        "name_prefix": "Mrs.",
        "credential": "L.C.S.W.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-10",
        "last_updated": "2021-11-28",
        "certification_date": "2021-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS15266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "http://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysymc.svc/scalceg",
            "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": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2021; 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.