Individual provider Active NPI

Jasmin Domingo Reyes-Moncada, MD

  • Gynecologic Oncology Physician
  • Honolulu, HI
National Provider Identifier
1114456936
Registry record updated Sep 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
License
MDR-7274 Issued in HI
Practice address
1319 Punahou St Ste 824
Honolulu, HI 96826-1032
Phone
(808) 203-6518
NPI assigned
Jun 6, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecologic Oncology Physician 207VX0201X MDR-7274 HI Primary

Addresses

Primary practice location

1319 Punahou St Ste 824
Honolulu, HI 96826-1032

Mailing address

21634 Retreat Pkwy
Temescal Valley, CA 92883-6100

Other names 1

  • Jasmin-Ann Domingo Reyes Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20220308001860 CA Practitioner - Obstetrics/Gynecology 3678967627 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of California, Geffen School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

9449 Imperial Hwy
Downey, CA 90242-2814
Phone (562) 461-3000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MDR-7274HIMDGynecologic Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Medical Clinic, Inc Current Accepting new patients
Riverside Medical Clinic, Inc CurrentSince Jan 15, 2022 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jul 28, 2022 Accepting new patients
Obhg California, P.C. CurrentSince May 11, 2022 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jul 28, 2022 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Riverside Medical Clinic, Inc CurrentSince Jan 15, 2022 Accepting new patients

Locations

9400 Rosecrans Ave
Bellflower, CA 90706
Phone (562) 461-6064

9333 Rosecrans Ave
Bellflower, CA 90706
Phone (562) 461-3340

800 S Main St
Corona, CA 92882
Phone (909) 625-5411

9449 Imperial Hwy
Downey, CA 90242
Phone (562) 657-2604

9333 Imperial Hwy
Downey, CA 90242
Phone (562) 657-8850

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

39000 Bob Hope Dr
Rancho Mirage, CA 92270
Phone (760) 340-3911

3660 Arlington Ave
Riverside, CA 92506
Phone (951) 782-3789

21634 Retreat Pkwy
Temescal Valley, CA 92883
Phone (951) 782-5157

Organizations & group practices 7

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": "1496707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662076800000",
    "number": "1114456936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21634 RETREAT PKWY",
            "city": "TEMESCAL VALLEY",
            "state": "CA",
            "postal_code": "928836100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1319 PUNAHOU ST STE 824",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968261032",
            "telephone_number": "808-203-6518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYES-MONCADA",
        "first_name": "JASMIN",
        "middle_name": "DOMINGO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-06",
        "last_updated": "2022-09-02",
        "certification_date": "2021-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "HI",
            "license": "MDR-7274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9400 Rosecrans Ave",
            "city": "Bellflower",
            "state": "CA",
            "country_code": "US",
            "postal_code": "907062246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JASMIN-ANN",
            "last_name": "REYES",
            "middle_name": "DOMINGO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.