Harry Avellona, NURSE PRACTITIONER
Individual provider Active NPI Nurse Practitioner · Mission Hills, CA
NPI 1861992141 · NPPES record last updated Nov 19, 2019
Key facts
- NPI
- 1861992141
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 95009004 (CA)
- Practice address
- 11333 Sepulveda Blvd
Mission Hills, CA 91345 - Phone
- (818) 869-7254
- NPI assigned
- Feb 13, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Providence Facey Medical Foundation
Practice addresses (Care Compare)
11333 Sepulveda Blvd
Mission Hills, CA 91345-1116
Phone (818) 365-9531
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191125001969 | CA | Practitioner - Nurse Practitioner | 0547693954 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20120540 | IL | MD | Diabetes Educator Registered Nurse |
Practice roles (3 of 4)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Facey Medical Foundation | Current |
Accepting new patients | |
| Providence Facey Medical Foundation | Current |
Accepting new patients | |
| Dignity Community Care | Past | Accepting new patients |
Locations
File 50670
Los Angeles, CA 90074
11333 Sepulveda Blvd
Fl 2
Mission Hills, CA 91345
Phone (818) 869-7263
11333 Sepulveda Blvd
Mission Hills, CA 91345
Phone (818) 365-9531
18460 Roscoe Blvd
Northridge, CA 91325
Phone (818) 734-3600
19950 Rinaldi St
Ste 103
Porter Ranch, CA 91326
Phone (818) 403-2400
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- havellona1168002@oc.providencedirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 95009004 | CA | Yes |
| Diabetes Educator Registered Nurse | 163WD0400X | 20120540 | IL |
Addresses
Primary practice location
11333 Sepulveda Blvd
Mission Hills, CA 91345
Mailing address
PO Box 9602
Mission Hills, CA 91346-9602
Phone (818) 837-5559
Other practice location 1
27118 Brown Oaks Way
Santa Clarita, CA 91387-3894
Phone (818) 634-2778
Other practice location 2
11333 Sepulveda Blvd
Mission Hills, CA 91345
Phone (818) 869-7254
Other providers in Mission Hills, CA
- Assisted Caregiver Services
- Assisted Home Care, Inc
- Assisted Home Recovery, Inc.
- Josef Astor
- Brian Patrick Austin
- Avenue Drug & Alcohol Treatment Center
- Christine Elise Averill
- Alessandro A Avila
- Sofia Avitia
- Veronica Nicole Ayala
All providers in Mission Hills, CA · Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.