Individual provider Active NPI

Stacey Kate Bernardo, DO

  • Family Medicine Physician
  • Temecula, CA
National Provider Identifier
1821594086
Registry record updated Jul 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A17734 Issued in CA
Practice address
28780 Single Oak Dr Ste 160
Temecula, CA 92590-5528
Phone
(951) 252-8650
NPI assigned
Apr 4, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A17734 CA Primary

Addresses

Primary practice location

28780 Single Oak Dr Ste 160
Temecula, CA 92590-5528

Mailing address

28780 Single Oak Dr Ste 160
Temecula, CA 92590-5528

Other names 1

  • Stacey Kate Lumabao Former name

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210727002412 CA Practitioner - Family Practice 5597168666 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rancho Family Medical Group IncGroup PAC ID 6305741240, 112 clinicians

Practice addresses (Care Compare)

28780 Single Oak Dr
Suite 160
Temecula, CA 92590-5528
Phone (951) 676-4193

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A17734CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm CurrentSince Feb 1, 2024 Accepting new patients
Sac Health System CurrentSince Feb 1, 2024 Accepting new patients
Sac Health System Current Accepting new patients
Faculty Physicians and Surgeons of Llusm Family Medicine CurrentSince Feb 1, 2024 Accepting new patients
Rancho Family Medical Group, Inc. Family Medicine CurrentSince Sep 1, 2021 Accepting new patients
Sac Health System CurrentSince Feb 1, 2024 Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
UC San Diego Health - Rancho Family Medical Group Past Accepting new patients
Regents of the University of California Past Accepting new patients
Temecula Valley Hospital Inc Past Accepting new patients

Locations

81 Highland Springs Ave
Ste 103
Beaumont, CA 92223
Phone (909) 558-2830

263 Church Ave
Chula Vista, CA 91910
Phone (619) 422-1324

82934 Civic Center Dr
Indio, CA 92201
Phone (760) 477-0733

11234 Anderson St
#A600
Loma Linda, CA 92350
Phone (909) 558-2824

11234 Anderson St
Loma Linda, CA 92350
Phone (909) 558-3016

11234 Anderson St
Ste C
Loma Linda, CA 92350
Phone (909) 558-4074

25455 Barton Rd
Ste 108A
Loma Linda, CA 92354
Phone (909) 558-1617

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

41011 California Oaks Rd
Ste 103
Murrieta, CA 92562
Phone (951) 225-6287

28078 Baxter Rd
Ste 540
Murrieta, CA 92563
Phone (909) 381-7100

250 S G St
San Bernardino, CA 92410
Phone (909) 771-2990

1455 3rd Ave
Sn Bernrdno, CA 92408
Phone (909) 382-7146

27190 Sun City Blvd
Sun City, CA 92586
Phone (951) 723-3804

28780 Single Oak Dr
Ste 160
Temecula, CA 92590
Phone (951) 658-9461

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: slumabao106135@direct.llu.edu

Organizations & group practices 10

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": "1522800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626652800000",
    "number": "1821594086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28780 SINGLE OAK DR STE 160",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925905528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28780 SINGLE OAK DR STE 160",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925905528",
            "telephone_number": "951-252-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERNARDO",
        "first_name": "STACEY",
        "middle_name": "KATE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-04",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A17734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "LUMABAO",
            "middle_name": "KATE",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Temecula, CA

Sources for this page

Verify at the official NPI Registry.