EDDIELYN MANGLALLAN FNP
NPI 1205092301
Nurse Practitioner - Family in Sacramento, CA
About Eddielyn Manglallan Fnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
EDDIELYN MANGLALLAN FNP (NPI 1205092301) is an individual family provider in Sacramento, California, licensed in California (NP 17965) and active in the NPI registry since July 2008. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Eddielyn Manglallan Fnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Eddielyn Manglallan reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Stockton, CA 95210
- Reassigned Medicare billing, California enrollment
- 20,078 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 95816 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 12
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Eddielyn Manglallan's NPI number?
The NPI number for Eddielyn Manglallan is 1205092301. It was assigned to this individual provider in the NPPES registry on July 29, 2008.
Where is Eddielyn Manglallan located?
Eddielyn Manglallan practices at 3701 J St Suite # 201, Sacramento, CA 95816. The listed phone number is (916) 454-2345.
What is Eddielyn Manglallan's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Eddielyn Manglallan enrolled in Medicare?
Yes. Eddielyn Manglallan is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Eddielyn Manglallan's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Eddielyn Manglallan reassigns Medicare benefits to Permanente Medical Group Inc (Stockton, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Eddielyn Manglallan's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Eddielyn Manglallan was last updated on January 3, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Eddielyn Manglallan, FNP · NPI 1205092301
Family physician in Sacramento, California. Individual provider, active in the CMS NPPES registry since July 29, 2008.
## Identity
- **NPI:** 1205092301 (Entity type: Individual)
- **Enumerated:** July 29, 2008
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** NP 17965 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 3701 J ST, SUITE # 201, Sacramento, CA 95816-5562
- **Phone:** (916) 454-2345 · **Fax:** (916) 457-2667
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Permanente Medical Group Inc (NPI 1548343510, Stockton, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 3, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1205092301) · Data from the CMS NPPES public registry.