Carly Anne Bronson, R.N., NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95001879 Issued in CA

Practice address

41820 Garstin Dr.
Big Bear Lake, CA 92315

Phone

(909) 878-8246

Fax

(909) 878-8294

NPI assigned

Apr 18, 2007

Last updated

Aug 3, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 3

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

Specialty

Nurse Practitioner

Education

Case Western University School of Dental Medicine, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bear Valley Community Health Care DistrictGroup PAC ID 0345138582, shared by 3 NPIs, 28 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bear Valley Community Hospital Hospital, Big Bear Lake, CA, CCN 051335

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Practice roles

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.

• Bear Valley Community Health Care District

  dba Bear Valley Community Hospital

  • Long Term Care Pharmacy
  • Big Bear Lake, CA
  • NPI 1073553756
  NPD (past)

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

• Bear Valley Community Health Care District

  dba Bear Valley Community Hospital

  • Long Term Care Pharmacy
  • Big Bear Lake, CA
  • NPI 1073553756

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691020800000",
    "number": "1962628719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1649",
            "city": "BIG BEAR LAKE",
            "state": "CA",
            "postal_code": "923151649",
            "telephone_number": "909-878-8246",
            "fax_number": "909-878-8294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41820 GARSTIN DR.",
            "city": "BIG BEAR LAKE",
            "state": "CA",
            "postal_code": "92315",
            "telephone_number": "909-878-8246",
            "fax_number": "909-878-8294"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "42683 Moonridge Rd",
            "address_purpose": "LOCATION",
            "city": "Big Bear Lake",
            "state": "CA",
            "postal_code": "92315",
            "country_code": "US",
            "telephone_number": "909-436-8197",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1028 W Big Bear Blvd",
            "address_purpose": "LOCATION",
            "city": "Big Bear City",
            "state": "CA",
            "postal_code": "923149562",
            "country_code": "US",
            "telephone_number": "909-878-8227",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRONSON",
        "first_name": "CARLY",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "R.N., NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-18",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "VT",
            "license": "101-0033221",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NH",
            "license": "060326-23",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "COA.12102-NP",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95001879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19626228719",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013302",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013302",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• BK Surgical Inc
• Ronald S Blustein, M.D.
• Peter S. Boss, M.D.
• Linda Bracken
• Robin Ann Bradley, P.H.D
• Jaimi Lynaire Brown
• Chauchabar Bruhwiler, ACUPUNCTURIST
• John W Bulrice, PAC
• Gaye Erin Bumstead, B.A. SOCIAL WORK
• Chasity Lynn Burke

• Family Nurse Practitioner in Big Bear Lake, CA
• Providers in Big Bear Lake, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 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.