Individual provider Active NPI

Ecler Ercole Jaqua, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • Loma Linda, CA
National Provider Identifier
1003235235
Registry record updated Dec 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
A143997 Issued in CA
Practice address
25455 Barton Rd Ste 204B
Loma Linda, CA 92354-3130
Phone
(909) 558-6600
NPI assigned
Apr 15, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A143997 CA
Geriatric Medicine (Family Medicine) Physician 207QG0300X A143997 CA Primary

Addresses

Primary practice location

25455 Barton Rd Ste 204B
Loma Linda, CA 92354-3130

Mailing address

File # 54701
Los Angeles, CA 90074-4701
Phone (909) 558-6600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180622002740 CA Practitioner - Geriatric MedicinePractitioner - Family Practice 8628357639 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
88.87 of 100Reported as group
Quality
72.13
Promoting interoperability
80
Improvement activities
40
Cost
77.36

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
143997CAMDMarriage & Family Therapist
A143997CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm CurrentSince Jul 1, 2018 Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm Family Medicine CurrentSince Jul 1, 2018 Accepting new patients

Locations

81 Highland Springs Ave
Ste 103
Beaumont, CA 92223
Phone (909) 558-2830

25455 Barton Rd
Ste 204B
Loma Linda, CA 92354
Phone (909) 558-6526

11370 Anderson St
#B100
Loma Linda, CA 92354
Phone (909) 558-2848

25455 Barton Rd
Ste 108A
Loma Linda, CA 92354
Phone (909) 558-1617

11234 Anderson St
#A600
Loma Linda, CA 92350
Phone (909) 558-2824

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

File 54701
Los Angeles, CA 90074
Phone (909) 651-4300

25828 Redlands Blvd
Ste 102
Redlands, CA 92373
Phone (909) 558-6856

Interoperability endpoints

  • Direct secure messaging: ejaqua72569@direct.llu.edu

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671148800000",
    "number": "1003235235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE # 54701",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900744701",
            "telephone_number": "909-558-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25455 BARTON RD STE 204B",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543130",
            "telephone_number": "909-558-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAQUA",
        "first_name": "ECLER",
        "middle_name": "ERCOLE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-15",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A143997",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A143997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.