Individual provider Active NPI

Jen-Gu Lin

  • Nurse Practitioner
  • Moreno Valley, CA
National Provider Identifier
1922350537
Registry record updated Apr 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95013806 Issued in CA
Practice address
26520 Cactus Ave
Moreno Valley, CA 92555-3927
Phone
(909) 558-4910
NPI assigned
Oct 5, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 95013806 CA Primary

Addresses

Primary practice location

26520 Cactus Ave
Moreno Valley, CA 92555-3927

Mailing address

26520 Cactus Ave
Moreno Valley, CA 92555-3927
Phone (909) 558-4910

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
I20200710000752 CA Practitioner - Nurse Practitioner 7810310786 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

3555 Round Barn Cir
Santa Rosa, CA 95403-1757
Phone (707) 528-1050

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.48 of 100Reported as group
Quality
80.12
Promoting interoperability
100
Improvement activities
40
Cost
71.46

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation CurrentSince Nov 13, 2025 Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Providence Medical Foundation Current Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Aug 1, 2020 Accepting new patients
Providence Medical Foundation CurrentSince Nov 13, 2025 Accepting new patients
El Camino Health Medical Network, LLC CurrentSince Jun 1, 2024 Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Aug 1, 2020 Accepting new patients
El Camino Health Medical Group Past Accepting new patients
Providence Medical Foundation Past Accepting new patients

Locations

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

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

815 Pollard Rd
Los Gatos, CA 95032
Phone (408) 378-6131

26520 Cactus Ave
Moreno Valley, CA 92555
Phone (951) 486-5610

2505 Hospital Dr
Mountain View, CA 94040
Phone (650) 940-7015

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

3555 Round Barn Cir
Santa Rosa, CA 95403
Phone (707) 528-1050

Interoperability endpoints

  • Direct secure messaging: jlin310954@direct.llu.edu
  • Direct secure messaging: jlin176118@icare.elcaminohospital.org

Organizations & group practices 9

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1349395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588204800000",
    "number": "1922350537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26520 CACTUS AVE",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925553927",
            "telephone_number": "909-558-4910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26520 CACTUS AVE",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925553927",
            "telephone_number": "909-558-4910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIN",
        "first_name": "JEN-GU",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-10-05",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95013806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moreno Valley, CA

Sources for this page

Verify at the official NPI Registry.