BIANCA NEEMA WIBISONO PA-C
NPI 1134812548
Physician Assistant in San Jose, CA

Active since May 31, 2023PECOS EnrolledAccepts Medicare Assignment
1071 BLOSSOM HILL RD, SAN JOSE, CA 95123(408) 445-4020 Get Directions Write a Review

NPPES record last updated: September 13, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Bianca Neema Wibisono Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BIANCA NEEMA WIBISONO PA-C (NPI 1134812548) is an individual physician assistant in San Jose, California, licensed in California (62531) and active in the NPI registry since May 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1134812548
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameBIANCA NEEMA WIBISONOCredential: PA-C
Location Address1071 BLOSSOM HILL RDSan Jose, CA 95123-1105
Mailing Address325 Distel CirLos Altos, CA 94022-1408
Sole ProprietorNo
Medical School CMSOtherGraduated 2022
Enumeration DateMay 31, 2023
Last NPPES UpdateSeptember 13, 2023
NPPES CertifiedSeptember 13, 2023
NPI 1134812548 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License Licensed in CA · 62531
Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

1071 BLOSSOM HILL RD, San Jose, CA 95123

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Bianca Neema Wibisono Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7911361282
PECOS Enrollment IDI20230920000037
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95123 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$106.47 typical visit price
range $70.37 – $206.04
Typical copayment $26.61 (range $17.59 – $51.51)
Most-billed visit code 99203
Established Patient
$86.56 typical visit price
range $23.96 – $169.60
Typical copayment $21.64 (range $5.99 – $42.40)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physician Assistant
1071 BLOSSOM HILL RD
SAN JOSE, CA 95123
Family Medicine
1071 BLOSSOM HILL RD
SAN JOSE, CA 95123
Pediatrics
1071 BLOSSOM HILL RD
SAN JOSE, CA 95123
Internal Medicine
1071 BLOSSOM HILL RD
SAN JOSE, CA 95123
Dermatology
1071 BLOSSOM HILL RD
SAN JOSE, CA 95123
Internal Medicine
1071 BLOSSOM HILL RD
SAN JOSE, CA 95123
Physician Assistant
1071 BLOSSOM HILL RD
SAN JOSE, CA 95123
Family Medicine
1071 BLOSSOM HILL RD
SAN JOSE, CA 95123

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1134812548, enumerated as an "individual" on May 31, 2023.

The provider is located at 1071 BLOSSOM HILL RD SAN JOSE, CA 95123 and the phone number is (408) 445-4020.

Physician Assistant with taxonomy code 363A00000X.