Jonathan Wibisono, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95004343 Issued in CA

Practice address

851 E 6TH St
Suite B-4
Beaumont, CA 92223-2340

Phone

(951) 845-2294

NPI assigned

Jul 18, 2016

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

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.

• Apex Urgent Care, Inc

  • Urgent Care Clinic/Center
  • Beaumont, CA
  • NPI 1043493299
  NPD (past)

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

{
    "created_epoch": "1468800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468800000000",
    "number": "1992158653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "851 E 6TH ST",
            "address_2": "SUITE B-4",
            "city": "BEAUMONT",
            "state": "CA",
            "postal_code": "922232340",
            "telephone_number": "951-845-2294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 E 6TH ST",
            "address_2": "SUITE B-4",
            "city": "BEAUMONT",
            "state": "CA",
            "postal_code": "922232340",
            "telephone_number": "951-845-2294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIBISONO",
        "first_name": "JONATHAN",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-18",
        "last_updated": "2016-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95004343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lydiah K Wanjau
• Monica Marie Ward
• Cassandra E Watkins
• Wesco Medical Supply &Equipment Co. Inc.
• Richard G. Whitehurst III, D.O.
• Briana Alyse Williams
• Dean Wines, DC
• Gary D Wines, D.C.
• Matthew Robert Wines, D.C.
• Esther Wolfkill, PT, DPT

• Nurse Practitioner in Beaumont, CA
• Providers in Beaumont, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.