Individual provider Active NPI

Jantje Matthew Groot, MD

  • Psychiatry Physician
  • Ventura, CA
National Provider Identifier
1083859912
Registry record updated May 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A102213 Issued in CA
Practice address
4258 Telegraph Rd
Ventura, CA 93003-3706
Phone
(805) 477-5700
Fax
(805) 644-5245
NPI assigned
Dec 5, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X A102213 CA Primary

Addresses

Primary practice location

4258 Telegraph Rd
Ventura, CA 93003-3706

Mailing address

800 S Victoria Ave, L4615
Vchca - Physician Services
Ventura, CA 93009-0003
Phone (805) 677-5181

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
I20090306000176 CA Practitioner - Psychiatry 1850457474 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of California, Irvine, California College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of VenturaGroup PAC ID 7911810171, 340 clinicians

Practice addresses (Care Compare)

300 Hillmont Ave
Ventura, CA 93003-1651
Phone (805) 654-3306

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A102213CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Ventura Current Accepting new patients
County of Ventura CurrentSince May 15, 2019 Accepting new patients
County of Ventura Current Accepting new patients
County of Ventura CurrentSince May 15, 2019 Accepting new patients

Locations

800 S Victoria Ave
#L4640
Ventura, CA 93009

800 S Victoria Ave
#L4615
Ventura, CA 93009
Phone (805) 677-5181

4258 Telegraph Rd
Ventura, CA 93003
Phone (805) 477-5700

300 Hillmont Ave
Ventura, CA 93003
Phone (805) 652-6000

Organizations & group practices 4

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": "1228435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621555200000",
    "number": "1083859912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 S VICTORIA AVE, L4615",
            "address_2": "VCHCA - PHYSICIAN SERVICES",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930090003",
            "telephone_number": "805-677-5181",
            "fax_number": "805-677-5304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4258 TELEGRAPH RD",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930033706",
            "telephone_number": "805-477-5700",
            "fax_number": "805-644-5245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROOT",
        "first_name": "JANTJE",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-12-05",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A102213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ventura, CA

Sources for this page

Verify at the official NPI Registry.