Individual provider Active NPI

Eduardo Longsworth

  • Psychiatric/Mental Health Nurse Practitioner
  • San Bernardino, CA
National Provider Identifier
1871242669
Registry record updated Feb 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95025356 Issued in CA
Practice address
1481 Windsor Dr
San Bernardino, CA 92404-5416
Phone
(909) 361-6470
NPI assigned
Mar 21, 2022
Last updated
Feb 17, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 95182846 CA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95025356 CA Primary
Nurse Practitioner 363L00000X 95025356 CA

Addresses

Primary practice location

1481 Windsor Dr
San Bernardino, CA 92404-5416

Mailing address

14135 Main St Ste 301
Hesperia, CA 92345-8095

Electronic endpoints 1

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

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240822002163 CA Practitioner - Nurse Practitioner 2769921725 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

9961 Sierra Ave
Fontana, CA 92335-6720
Phone (909) 427-5000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
95182846CAMDRegistered Nurse
95025356CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - Psychiatry PC CurrentSince Sep 1, 2024 Accepting new patients
Cep America - Psychiatry PC CurrentSince Sep 1, 2024 Accepting new patients
Southern California Permanente Medical Group CurrentSince Feb 8, 2025 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Cep America - Psychiatry PC Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Feb 8, 2025 Accepting new patients
Telecare Corporation Past Accepting new patients

Locations

400 N Pepper Ave
Colton, CA 92324
Phone (909) 580-1400

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

14135 Main St
Ste 301
Hesperia, CA 92345
Phone (760) 947-5220

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 350-2663

393 E Walnut St
Fl 5
Pasadena, CA 91188
Phone (310) 403-3235

Organizations & group practices 7

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": "1647820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771286400000",
    "number": "1871242669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14135 MAIN ST STE 301",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923458095",
            "fax_number": "760-947-3257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1481 WINDSOR DR",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924045416",
            "telephone_number": "909-361-6470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONGSWORTH",
        "first_name": "EDUARDO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-21",
        "last_updated": "2026-02-17",
        "certification_date": "2026-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95182846",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95025356",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95025356",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "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 San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.