Jessica S. Craig, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A80156 Issued in CA

Practice address

201 9TH St
Marina, CA 93933-6039

Phone

(831) 884-1171

Fax

(831) 884-1024

NPI assigned

Nov 15, 2006

Last updated

Sep 25, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Jessica Sakhone Bouasangouane Professional name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664064000000",
    "number": "1003988759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 9TH ST",
            "city": "MARINA",
            "state": "CA",
            "postal_code": "939336039",
            "telephone_number": "831-884-1171",
            "fax_number": "831-884-1024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 9TH ST",
            "city": "MARINA",
            "state": "CA",
            "postal_code": "939336039",
            "telephone_number": "831-884-1171",
            "fax_number": "831-884-1024"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "75-5751 Kuakini Hwy",
            "address_2": "Suite 104",
            "address_purpose": "LOCATION",
            "city": "Kailua Kona",
            "state": "HI",
            "postal_code": "967401752",
            "country_code": "US",
            "telephone_number": "808-326-5629",
            "fax_number": "808-329-5057",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRAIG",
        "first_name": "JESSICA",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2022-09-25",
        "certification_date": "2022-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "HI",
            "license": "MD17221",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A80156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4663239",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "BOUASANGOUANE",
            "middle_name": "SAKHONE",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• County of Monterey (Monterey County Health Clinic at Marina)
• County of Monterey (Monterey County Health Clinic at Marina)
• County of Monterey (Monterey County Integrated Health Clinic)
• Stephanie Covarrubias
• Lindsay Christine Cox, MSNFNP
• Catrina Mariah Cruz-Reyes
• Daisy Cuevas
• Allyson Rose Cumella, LCSW
• Aine Mary Daly, PPS
• Tram Anh Dang

• Family Medicine Physician in Marina, CA
• Providers in Marina, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.