Carol Anne McCormick, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

23089 Issued in CA

Practice address

2400 Mission St
San Marino, CA 91108

Phone

(626) 403-8989

Fax

(626) 403-8969

NPI assigned

Aug 1, 2006

Last updated

Nov 3, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 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, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

San Marino Psychiatric Associates IncGroup PAC ID 6709864895, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/BFCDAD

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.

• San Marino Psychiatric Associates, Inc.

  • Psychiatry Physician
  • San Marino, CA
  • NPI 1063540938
  Medicare reassignment Care Compare group NPD
• The Roads Foundation, Inc.

  dba ROADS Community Care Clinic

  • Community Health Clinic/Center
  • Compton, CA
  • NPI 1508278359
  NPD

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414972800000",
    "number": "1821004458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4525 E ATHERTON ST",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908153700",
            "telephone_number": "562-961-0155",
            "fax_number": "562-961-0161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 MISSION ST",
            "city": "SAN MARINO",
            "state": "CA",
            "postal_code": "91108",
            "telephone_number": "626-403-8989",
            "fax_number": "626-403-8969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "CAROL",
        "middle_name": "ANNE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2014-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "23089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2771086",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• LSCJ
• Harvey A Luu, DDS
• Maricarmen Madrigal
• Thomas J Maxwell, M.D.
• Berry L. McCord, M.D.
• Emily Hortenstine McDowell, PA-C
• Brent McMahon, PT
• Rochelle Medici, PHD
• Medipro Medical Group Inc
• Rita Fogata Mejia, RDN

• Psychiatric/Mental Health Nurse Practitioner in San Marino, CA
• Providers in San Marino, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2014; 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.