Individual provider Active NPI

Jessica Lynn Thackaberry, M.D.

  • Psychiatry Physician
  • San Diego, CA
National Provider Identifier
1134478910
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A128967 Issued in CA
Practice address
200 W Arbor Dr
San Diego, CA 92103-9000
Phone
(800) 926-8273
Fax
(888) 539-8781
NPI assigned
Sep 7, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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 A128967 CA Primary

Addresses

Primary practice location

200 W Arbor Dr
San Diego, CA 92103-9000

Mailing address

File 57326
Los Angeles, CA 90074-0001

Other practice location 1

3350 La Jolla Village Drive
San Diego, CA 92037
Phone (858) 534-4040

Other practice location 2

6645 Alvarado Rd
San Diego, CA 92120-5208
Phone (800) 926-6273

Other practice location 3

350 Dickinson St
San Diego, CA 92103-1913
Phone (800) 926-8273

Other practice location 4

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

Other names 1

  • Jessica Lynn Garrity Former name

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
I20140813000175 CA Practitioner - Psychiatry 4082831110 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Washington School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

200 W Arbor Dr
San Diego, CA 92103-9000
Phone (858) 249-6753

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.77 of 100Reported as group
Quality
84.13
Promoting interoperability
100
Improvement activities
40
Cost
73.88

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A128967CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clinicas de Salud del Pueblo, Inc CurrentSince Nov 6, 2018 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Current Accepting new patients
Regents of the University of California Psychiatry CurrentSince Jun 30, 2016 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro Inc CurrentSince Aug 8, 2017 Accepting new patients
County of San Diego CurrentSince Jul 1, 2014 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Aug 29, 2022 Accepting new patients
County of San Diego Current Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. CurrentSince Aug 8, 2017 Accepting new patients
Clinicas de Salud del Pueblo Inc. CurrentSince Nov 6, 2018 Accepting new patients
Clinicas de Salud del Pueblo, Inc Current Accepting new patients
Regents of the University of California CurrentSince Jun 30, 2016 Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients
County of San Diego CurrentSince Jul 1, 2014 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Aug 29, 2022 Accepting new patients

Locations

321 W Hobsonway
Ste C
Blythe, CA 92225
Phone (760) 922-4981

1637 Third Ave
Ste B
Chula Vista, CA 91911
Phone (619) 425-1780

1000 Broadway
Ste 210
El Cajon, CA 92021
Phone (619) 401-5500

File 57326
Los Angeles, CA 90074

1136 D Ave
National City, CA 91950
Phone (619) 336-2300

6645 Alvarado Rd
San Diego, CA 92120
Phone (619) 229-3172

4094 4th Ave
San Diego, CA 92103
Phone (619) 515-2545

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

3177 Ocean View Blvd
San Diego, CA 92113
Phone (619) 231-9300

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

1250 Morena Blvd
San Diego, CA 92110
Phone (619) 692-8715

6655 Alvarado Rd
San Diego, CA 92120
Phone (619) 229-3130

200 W Arbor Dr
#8201
San Diego, CA 92103
Phone (858) 534-6290

350 Dickinson St
San Diego, CA 92103
Phone (619) 543-6635

3853 Rosecrans St
San Diego, CA 92110
Phone (619) 615-0439

4004 Beyer Blvd
San Ysidro, CA 92173
Phone (619) 428-1330

Interoperability endpoints

  • Direct secure messaging: jessica.thackberry.p1@direct.cdsdp.nextgenshare.com

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1346976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1134478910",
    "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": "900740001"
        },
        {
            "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": "3350 La Jolla Village Drive",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "92037",
            "country_code": "US",
            "telephone_number": "858-534-4040",
            "fax_number": "858-822-0231",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6645 Alvarado Rd",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921205208",
            "country_code": "US",
            "telephone_number": "800-926-6273",
            "fax_number": "888-539-8781",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "350 Dickinson St",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921031913",
            "country_code": "US",
            "telephone_number": "800-926-8273",
            "fax_number": "888-539-8781",
            "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"
        }
    ],
    "basic": {
        "last_name": "THACKABERRY",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-07",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A128967",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "GARRITY",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.