Individual provider Active NPI

Jessica Holdaway

  • Emergency Medicine Physician
  • San Diego, CA
National Provider Identifier
1164982260
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A178151 Issued in CA
Practice address
200 W Arbor Dr # Mc8676
San Diego, CA 92103-1911
Phone
(619) 543-6213
Fax
(619) 543-3115
NPI assigned
Mar 23, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X A178151 CA Primary

Addresses

Primary practice location

200 W Arbor Dr # Mc8676
San Diego, CA 92103-1911

Mailing address

200 W Arbor Dr # Mc8676
San Diego, CA 92103-1911
Phone (619) 543-6213

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230811002150 CA Practitioner - Emergency Medicine 6305208091 Reassigns benefits to 2 organizations
I20250402003501 WA Practitioner - Emergency Medicine 6305208091 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Rochester School of Medicine and Dentistry, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Olympia Emergency Services PLLCGroup PAC ID 9335035633, 31 clinicians

Practice addresses (Care Compare)

413 Lilly Rd NE
Olympia, WA 98506-5133
Phone (360) 493-4554

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.47 of 100Reported as group
Quality
85.24
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A178151CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Palomar Emergency Physicians, Inc Emergency Medicine CurrentSince Aug 1, 2023 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro Inc CurrentSince Jul 1, 2023 Accepting new patients
Olympia Emergency Services, PLLC Emergency Medicine CurrentSince Mar 1, 2025 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Current Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. CurrentSince Jul 1, 2023 Accepting new patients

Locations

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

333 H St
Ste 2080
Chula Vista, CA 91910

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

15615 Pomerado Rd
Poway, CA 92064
Phone (858) 613-4000

1601 Precision Park Ln
San Ysidro, CA 92173
Phone (619) 205-4585

413 Lilly Rd NE
Olympia, WA 98506
Phone (360) 491-9480

Interoperability endpoints

  • Direct secure messaging: jholdaway19127@syhealth.direct-ci.com

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1553299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1164982260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W ARBOR DR # MC8676",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921031911",
            "telephone_number": "619-543-6213",
            "fax_number": "619-543-3115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W ARBOR DR # MC8676",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921031911",
            "telephone_number": "619-543-6213",
            "fax_number": "619-543-3115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLDAWAY",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-23",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A178151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.