Festus Idahosa-Erese, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

C14079 Issued in CA

Practice address

716 E Main St
Barstow, CA 92311-2354

Phone

(760) 953-8059

NPI assigned

Aug 8, 2006

Sex

Male

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Maithri N. Weerasinghe MD Inc

  dba Dr Mike's Walk In Clinic

  • Family Medicine Physician
  • Barstow, CA
  • NPI 1295745743
  Medicare reassignment
• Dr.Mikel Walk in Clinic Inc

  • Family Medicine Physician
  • Hesperia, CA
  • NPI 1346250396
  NPD (past)

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871503342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 487",
            "city": "BARSTOW",
            "state": "CA",
            "postal_code": "923120487",
            "telephone_number": "760-953-8059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 E MAIN ST",
            "city": "BARSTOW",
            "state": "CA",
            "postal_code": "923112354",
            "telephone_number": "760-953-8059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDAHOSA-ERESE",
        "first_name": "FESTUS",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "C14079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER'S LICENSE",
            "identifier": "C1584129",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jan Murray Hughes, OT
• Kensharra Shanay Humphrey
• Alisha Hunt
• Nickolas Sloan Huston
• Robert Michael Hutchman, MD
• J Shay Anesthesia and Pain Management (JS Anesthesia and Pain Management)
• Lewis F Jablonski
• Antoinette D Jackson
• Sharde Jackson
• Yolanda Chaute Jackson

• Physician Assistant in Barstow, CA
• Providers in Barstow, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.