Jennifer A. Ellstrom, C.NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R-134002-8 Issued in MN

Practice address

7117 Brockton Ave
Riverside Medical Clinic
Riverside, CA 92506-2658

Phone

(951) 784-3269

Fax

(951) 784-3269

NPI assigned

Oct 19, 2009

Last updated

Dec 10, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Faculty Physicians and Surgeons of Llusm

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Apple Valley, CA
  • NPI 1205009917
  Medicare reassignment NPD
• Riverside Medical Clinic, Inc

  dba Riverside Medical Clinic

  • Dermatology Physician
  • Riverside, CA
  • NPI 1720183403
  Medicare reassignment NPD
• Faculty Physicians and Surgeons of Llusm

  • Pediatrics Physician
  • Loma Linda, CA
  • NPI 1477503407
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Family Medicine Physician
  • Moreno Valley, CA
  • NPI 1558788331
  NPD
• Riverside Medical Clinic, Inc

  dba Riverside Medical Clinic

  • Family Medicine Physician
  • Murrieta, CA
  • NPI 1700295607
  NPD

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

{
    "created_epoch": "1255910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386633600000",
    "number": "1972839462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7117 BROCKTON AVE",
            "address_2": "RIVERSIDE MEDICAL CLINIC",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925062658",
            "telephone_number": "951-784-3269",
            "fax_number": "951-784-3269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7117 BROCKTON AVE",
            "address_2": "RIVERSIDE MEDICAL CLINIC",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925062658",
            "telephone_number": "951-784-3269",
            "fax_number": "951-784-3269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLSTROM",
        "first_name": "JENNIFER",
        "middle_name": "A.",
        "credential": "C.NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-19",
        "last_updated": "2013-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R-134002-8",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brett Jacob Ellison, DO
• Carrie Lynn Ellison
• Renaka Ellison
• Robert Kirk Elloway, D.D.S.
• Russell Elloway
• Melanie Elmange
• Maryam Elquza
• Sami W Elquza, LCSW
• Mina Elsabee, MD
• Rachel Elsanadi

• Family Nurse Practitioner in Riverside, CA
• Providers in Riverside, 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 Dec 10, 2013; 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.