Individual provider Active NPI

Jenna Rose Erickson, M.D.

  • Hospitalist Physician
  • Phoenix, AZ
National Provider Identifier
1073990149
Registry record updated Sep 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
56104 Issued in AZ
Practice address
1919 E Thomas Rd
Phoenix, AZ 85016
Phone
(602) 933-0777
Fax
(602) 933-0755
NPI assigned
Apr 28, 2015
Last updated
Sep 12, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 56104 AZ
Hospitalist Physician 208M00000X 56104 AZ Primary

Addresses

Primary practice location

1919 E Thomas Rd
Phoenix, AZ 85016

Mailing address

3200 E Camelback Rd Ste 250
Phoenix, AZ 85018-2327
Phone (602) 933-1813

Other names 1

  • Jenna Rose Mollison Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20181005001043 AZ Practitioner - HospitalistPractitioner - Pediatric Medicine 4385996198 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Pediatric Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Children's HospitalGroup PAC ID 0446278584, 431 clinicians

Practice addresses (Care Compare)

1919 E Thomas Rd
Phoenix, AZ 85016-7710
Phone (602) 933-0930

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
56104AZMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
District Medical Group, Inc CurrentSince Aug 15, 2018 Accepting new patients
District Medical Group, Inc Current Accepting new patients
Phoenix Children's Medical Group CurrentSince Sep 1, 2018 Accepting new patients
District Medical Group, Inc CurrentSince Aug 15, 2018 Accepting new patients
Phoenix Children's Hospital Pediatrics CurrentSince Sep 1, 2018 Accepting new patients

Locations

1665 N Avondale Blvd
Avondale, AZ 85392
Phone (602) 933-0005

19007 N 67th Ave
Glendale, AZ 85308
Phone (602) 933-1784

5131 E Southern Ave
Mesa, AZ 85206
Phone (480) 833-5437

9319 E Cadence Pkwy
Mesa, AZ 85212
Phone (602) 933-3400

1919 E Thomas Rd
Phoenix, AZ 85016
Phone (602) 933-0777

2525 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 344-1015

2601 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 220-0298

3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520

3200 E Camelback Rd
Ste 250
Phoenix, AZ 85018
Phone (602) 933-1814

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1430179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536710400000",
    "number": "1073990149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 E CAMELBACK RD STE 250",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850182327",
            "telephone_number": "602-933-1813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 E THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85016",
            "telephone_number": "602-933-0777",
            "fax_number": "602-933-0755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERICKSON",
        "first_name": "JENNA",
        "middle_name": "ROSE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-28",
        "last_updated": "2018-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "56104",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "AZ",
            "license": "56104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNA",
            "last_name": "MOLLISON",
            "middle_name": "ROSE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.