ALEXANDRA LAUREN PETTUS NURSE PRACTITIONER
NPI 1750148748
Nurse Practitioner - Family in San Bernardino, CA

Q: What is Alexandra Pettus's NPI number?

The NPI number for Alexandra Pettus is 1750148748. It was assigned to this individual provider in the NPPES registry on March 5, 2024.

Q: What is Alexandra Pettus's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Alexandra Pettus was last updated on March 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.

Active since March 05, 2024PECOS Enrolled

1800 WESTERN AVE STE 204, SAN BERNARDINO, CA 92411(909) 474-9952 Get Directions Write a Review

NPPES record last updated: March 5, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

On this page

About Alexandra Lauren Pettus Nurse Practitioner NPPES

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

ALEXANDRA LAUREN PETTUS NURSE PRACTITIONER (NPI 1750148748) is an individual family provider in San Bernardino, California, licensed in California (95028213) and active in the NPI registry since March 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1750148748

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameALEXANDRA LAUREN PETTUSCredential: NURSE PRACTITIONER

Location Address1800 WESTERN AVE STE 204San Bernardino, CA 92411-1353

Mailing Address945 S Ridgecrest CirAnaheim, CA 92807-4502 · (256) 620-1972

Phone(909) 474-9952

Sole ProprietorYes

Medical School CMSOtherGraduated 2024

Enumeration DateMarch 5, 2024

NPPES CertifiedMarch 3, 2024

✔ NPI 1750148748 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in CA · 95028213

1800 WESTERN AVE STE 204, San Bernardino, CA 92411

Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Alexandra Lauren Pettus Nurse Practitioner is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9234608571

PECOS Enrollment IDI20260515003135

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.

Medicare Billing Reassignment

Medicare enrollment records show Alexandra Pettus reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Clinica Prenatal San Jose, Inc.

44 mi

Obstetrics

1220 HEMLOCK WAY STE 200
Santa Ana, CA 92707

Reassigned Medicare billing, California enrollment
12 clinicians in this Medicare group

NPI 1508046251 (714) 966-9795

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 92411 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

$91.88 typical visit price

range $59.60 – $179.42

Typical copayment $22.97 (range $14.90 – $44.85)

Most-billed visit code 99203

Established Patient

$104.64 typical visit price

range $19.37 – $146.42

Typical copayment $26.16 (range $4.84 – $36.60)

Most-billed visit code 99214

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 15

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

JOE MAWAD MD

Obstetrics & Gynecology