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NISEBHO KEFELEGN FANTAYE PA-C
NPI 1942875778
Physician Assistant in Marysville, CA

Active since May 24, 2021PECOS Enrolled
726 4TH ST, MARYSVILLE, CA 95901(530) 749-4300 Get Directions Write a Review

NPPES record last updated: September 5, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 5, 2023, Jul 17, 2023, May 24, 2021 (3 updates tracked since 2021).

About Nisebho Kefelegn Fantaye Pa-c NPPES

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

NISEBHO KEFELEGN FANTAYE PA-C (NPI 1942875778) is an individual physician assistant in Marysville, California, licensed in California (62852) and active in the NPI registry since May 2021. He is enrolled in Medicare PECOS and maintains a secondary practice location in Vallejo.

NPPES Registry Identity

NPI1942875778
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameNISEBHO KEFELEGN FANTAYECredential: PA-C
Location Address726 4TH STMarysville, CA 95901-5656
Mailing Address726 4th StMarysville, CA 95901-5656
Phone(530) 749-4300
Sole ProprietorYes
Enumeration DateMay 24, 2021
Last NPPES UpdateSeptember 5, 20233 updates tracked since enumeration
NPPES CertifiedSeptember 5, 2023
✔ NPI 1942875778 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 · 62852
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.
726 4TH ST, Marysville, CA 95901
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Secondary Practice Location 1

Location 11310 Club DrVallejo, CA 94592-1187 · Phone (408) 509-0856

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nisebho Kefelegn Fantaye Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Emergency department visit with high level of medical decision making 99285
An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.
142 services140 patients
Emergency department visit with moderate level of medical decision making 99284
An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.
126 services122 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95901 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
$90.32 typical visit price
range $58.87 – $176.60
Typical copayment $22.58 (range $14.71 – $44.15)
Most-billed visit code 99203
Established Patient
$73.16 typical visit price
range $19.28 – $144.60
Typical copayment $18.29 (range $4.82 – $36.15)
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.

ELAINE HOILE
Physical Therapist
726 4TH ST
MARYSVILLE, CA 95901
Yuba County (530) 749-4300
KASHMIR SINGH M.D
Emergency Medicine
726 4TH ST
MARYSVILLE, CA 95901
Yuba County (530) 749-4300
JAMES BABESHOFF CRNA
Nurse Anesthetist, Certified Registered
726 4TH ST
MARYSVILLE, CA 95901
Yuba County (530) 749-4300
DENNIS DAN CARBALLO SY CRNA
Nurse Anesthetist, Certified Registered
726 4TH ST
MARYSVILLE, CA 95901
Yuba County (530) 751-4295
KARANDEEP KAUR
Speech-Language Pathologist
726 4TH ST
MARYSVILLE, CA 95901
Yuba County (530) 749-4300
DR. BRADLEY GRAUSZ D.O
Emergency Medicine
726 4TH ST
MARYSVILLE, CA 95901
Yuba County (530) 749-4511
MRS. KATHLEEN MARIE HIGGINBOTHAM M. A. CCC-SLP
Speech-Language Pathologist
726 4TH ST
MARYSVILLE, CA 95901
Yuba County (530) 749-4552
NATHAN DAVID NORTH
Registered Nurse (Registered Nurse First Assistant)
726 4TH ST
MARYSVILLE, CA 95901
Yuba County (530) 749-4300

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 Nisebho Fantaye's NPI number?

The NPI number for Nisebho Fantaye is 1942875778. It was assigned to this individual provider in the NPPES registry on May 24, 2021.

Where is Nisebho Fantaye located?

Nisebho Fantaye practices at 726 4th St, Marysville, CA 95901. The listed phone number is (530) 749-4300.

What is Nisebho Fantaye's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Nisebho Fantaye enrolled in Medicare?

Yes. Nisebho Fantaye is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Nisebho Fantaye was last updated on September 5, 2023. 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.