Nisebho Kefelegn Fantaye, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

62852 Issued in CA

Practice address

726 4TH St
Marysville, CA 95901-5656

Phone

(530) 749-4300

NPI assigned

May 24, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Merit-based Incentive Payment System (MIPS)

Final score

96.69 of 100Reported as group

Quality

90

Improvement activities

40

Cost

78.43

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nisebho.fantaye.p1@direct.peachtreehealth.nextgenshare.com

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.

• Cep America - California

  • Emergency Medicine Physician
  • San Francisco, CA
  • NPI 1023063542
  Medicare reassignment
• Cep America - California

  • Emergency Medicine Physician
  • Santa Ana, CA
  • NPI 1548667843
  Medicare reassignment
• Woodland Emergency Physicians Medical Group Inc

  • Emergency Medicine Physician
  • Woodland, CA
  • NPI 1881868164
  Medicare reassignment
• Cep America - California

  • Emergency Medicine Physician
  • Lynwood, CA
  • NPI 1932596848
  NPD
• Cep America-California

  • Emergency Medicine Physician
  • Delano, CA
  • NPI 1598534216
  NPD

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

{
    "created_epoch": "1621814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693872000000",
    "number": "1942875778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "726 4TH ST",
            "city": "MARYSVILLE",
            "state": "CA",
            "postal_code": "959015656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "726 4TH ST",
            "city": "MARYSVILLE",
            "state": "CA",
            "postal_code": "959015656",
            "telephone_number": "530-749-4300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1310 Club Dr",
            "address_purpose": "LOCATION",
            "city": "Vallejo",
            "state": "CA",
            "postal_code": "945921187",
            "country_code": "US",
            "telephone_number": "408-509-0856",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FANTAYE",
        "first_name": "NISEBHO",
        "middle_name": "KEFELEGN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-05-24",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "62852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pamela R Fallo, C.F.N.P
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• Rachel Farrell, PA
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• Elizabeth Anne Fegley, LPTA
• Dennis R Fellner, O.D
• Jeffrey Fernandez

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.