NPIMap

Individual provider Active NPI

Jenny Idicula

  • Certified Registered Nurse Anesthetist
  • San Diego, CA
National Provider Identifier
1083291637
Registry record updated Jun 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
95002777 Issued in CA
Practice address
200 W Arbor Dr
San Diego, CA 92103-9000
Phone
(800) 926-8273
Fax
(888) 539-8781
NPI assigned
Mar 28, 2021
Last updated
Jun 12, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 1052820 TX
Certified Registered Nurse Anesthetist 367500000X RNA253034 ME
Certified Registered Nurse Anesthetist 367500000X 95002777 CA Primary
Registered Nurse 163W00000X 860986 TX

Addresses

Primary practice location

200 W Arbor Dr
San Diego, CA 92103-9000

Mailing address

File 57326
Los Angeles, CA 90074-7326
Phone (800) 926-8273

Other practice location 1

84 Campus Dr
Scarborough, ME 04074-7133
Phone (207) 396-7000

Other practice location 2

25 June St
Sanford, ME 04073-2621
Phone (207) 490-7450

Other practice location 3

1 Medical Center Dr
Biddeford, ME 04005-9422
Phone (207) 283-7042

Other practice location 4

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 662-2526

Other practice location 5

6655 Alvarado Rd
San Diego, CA 92120-5208
Phone (800) 926-8273

Other practice location 6

9300 Campus Point Dr
LA Jolla, CA 92037-1300
Phone (800) 926-8273

Other practice location 7

3705 Medical Pkwy Ste 570
Austin, TX 78705-1024
Phone (512) 454-2554

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, ME, CA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20210907003189 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 5496151094 Reassigns benefits to 5 organizations
I20250813003346 ME Practitioner - Certified Registered Nurse Anesthetist (Crna) 5496151094 Reassigns benefits to 1 organization
I20260603001717 CA Practitioner - Certified Registered Nurse Anesthetist (Crna) 5496151094 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
R Franklin University of Med & Sci/Chicago Medical School, 2021
Medicare assignment
May accept Medicare assignment
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians
DFW Oba PLLCGroup PAC ID 0941684963, 20 clinicians

Practice addresses (Care Compare)

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905

3861 Long Prairie Rd
Suite 109
Flower Mound, TX 75028-1799
Phone (972) 350-0225

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.94 of 100Reported as group
Quality
91.31
Improvement activities
40
Cost
79.05

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
860986TXMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Aug 4, 2025 Accepting new patients
Mainehealth CurrentSince Aug 4, 2025 Accepting new patients
U S Anesthesia Partners of Texas, PA Nurse Anesthetist, Certified Registered CurrentSince Aug 12, 2021 Accepting new patients
DFW Oba PLLC CurrentSince Oct 31, 2025 Accepting new patients
U. S. Anesthesia Partners of Texas, P.a., Nurse Anesthetist, Certified Registered CurrentSince Aug 12, 2021 Accepting new patients
Mainehealth Current Accepting new patients
Mainehealth Past Accepting new patients

Locations

1 Medical Dr
Biddeford, ME 04005
Phone (207) 283-7000

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

25 June St
Sanford, ME 04073
Phone (207) 324-4310

84 Campus Dr
Scarborough, ME 04074
Phone (207) 396-7000

1201 W 38th St
Austin, TX 78705
Phone (512) 324-1058

4900 Mueller Blvd
Austin, TX 78723
Phone (512) 324-0165

100 Medical Dr
Lake Jackson, TX 77566
Phone (713) 496-7555

990 S Sherman St
Richardson, TX 75081
Phone (972) 788-0350

9250 Pinecroft Dr
Shenandoah, TX 77380
Phone (281) 364-2300

2118 E State Highway 114
Southlake, TX 76092
Phone (817) 488-0410

Organizations & group practices 12

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.

Hospital & facility affiliations 36

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1616889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781222400000",
    "number": "1083291637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE 57326",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900747326",
            "telephone_number": "800-926-8273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W ARBOR DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921039000",
            "telephone_number": "800-926-8273",
            "fax_number": "888-539-8781"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "84 Campus Dr",
            "address_purpose": "LOCATION",
            "city": "Scarborough",
            "state": "ME",
            "postal_code": "040747133",
            "country_code": "US",
            "telephone_number": "207-396-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "25 June St",
            "address_purpose": "LOCATION",
            "city": "Sanford",
            "state": "ME",
            "postal_code": "040732621",
            "country_code": "US",
            "telephone_number": "207-490-7450",
            "fax_number": "207-490-7452",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Biddeford",
            "state": "ME",
            "postal_code": "040059422",
            "country_code": "US",
            "telephone_number": "207-283-7042",
            "fax_number": "207-283-7047",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "22 Bramhall St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "ME",
            "postal_code": "041023134",
            "country_code": "US",
            "telephone_number": "207-662-2526",
            "fax_number": "207-662-6236",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6655 Alvarado Rd",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921205208",
            "country_code": "US",
            "telephone_number": "800-926-8273",
            "fax_number": "888-539-8781",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9300 Campus Point Dr",
            "address_purpose": "LOCATION",
            "city": "LA Jolla",
            "state": "CA",
            "postal_code": "920371300",
            "country_code": "US",
            "telephone_number": "800-926-8273",
            "fax_number": "888-539-8781",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3705 Medical Pkwy Ste 570",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787051024",
            "country_code": "US",
            "telephone_number": "512-454-2554",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IDICULA",
        "first_name": "JENNY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-28",
        "last_updated": "2026-06-12",
        "certification_date": "2026-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "1052820",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ME",
            "license": "RNA253034",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CA",
            "license": "95002777",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "860986",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.