Regina Marie Formentin, NP-C
NPI 1700470275ActiveIndividual· Nurse Practitioner· Mesa, AZ
Nurse Practitioner (NP-C) with Summit Medical Group Arizona LLC, practicing in Mesa, Arizona. 140 Medicare patients in 2024, $20,165 paid; nearly all of their 227 Part D prescriptions were generic (93%). Lists Banner Baywood Medical Center as a hospital affiliation.
Overview
| NPI | 1700470275 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | NP-C |
| Sole proprietor | Yes |
| NPI issued | Feb 25, 2021 |
| Last updated in NPPES | Aug 27, 2024 |
| Certified by provider | Aug 27, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner Primary | 363L00000X | 254655 | AZ |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Nurse Practitioner (AZ) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 140 |
|---|---|
| Services billed | 468 across 44 procedure codes |
| Paid by Medicare | $20,165 |
Part D prescriptions in 2024
| Prescriptions (claims) | 227 · 313 30-day fills |
|---|---|
| Patients | 110 |
| Total drug cost | $5,248 |
| Generic share | 93% of claims |
Education and affiliations
| Graduation year | 2020 |
|---|---|
| Medicare specialty | Nurse Practitioner |
| Telehealth | Offers telehealth |
Medical group
- Summit Medical Group Arizona LLCGlendale, AZ · 158 clinicians
Hospital affiliation
- Banner Baywood Medical CenterMesa, AZ
Other facilities
- American Home Health Services, Inc.Home health agency · Mesa, AZ
- Banner Home Care-ArizonaHome health agency · Mesa, AZ
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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