Annisa Nabila Soeboer, PA-C
NPI 1053985929ActiveIndividual· Physician Assistant· Fremont, CA
Physician Assistant (PA-C) in Fremont, California, trained at Touro Un College of Osteopathic Medicine, Vallejo (class of 2022). In 2024 Medicare paid $14,644 for 158 patients, and Part D covered 213 of their prescriptions, 87% of them generic.
Overview
| NPI | 1053985929 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | PA-C |
| Sole proprietor | No |
| NPI issued | May 16, 2021 |
| Last updated in NPPES | Mar 7, 2023 |
| Certified by provider | Sep 30, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant Primary | 363A00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physician Assistant (NY) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 158 |
|---|---|
| Services billed | 314 across 39 procedure codes |
| Paid by Medicare | $14,644 |
Part D prescriptions in 2024
| Prescriptions (claims) | 213 · 214 30-day fills |
|---|---|
| Patients | 150 |
| Total drug cost | $9,686 |
| Generic share | 87% of claims |
Education and affiliations
| Medical school | Touro Un College of Osteopathic Medicine, Vallejo |
|---|---|
| Graduation year | 2022 |
| Medicare specialty | Physician Assistant |
Medical group
- City Medical of Upper East Side PLLCAstoria, NY · 658 clinicians
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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All 73 physician assistants in Fremont · All physician assistants in California