Individual provider Active NPI

Jennifer Bianca Vincent, PA-C

  • Physician Assistant
  • San Juan Capistrano, CA
National Provider Identifier
1164986105
Registry record updated Dec 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA56467 Issued in CA
Practice address
31001 Rancho Viejo Rd #200
San Juan Capistrano, CA 92675
Phone
(949) 661-9600
Fax
(949) 443-6200
NPI assigned
Jan 23, 2019
Last updated
Dec 16, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA56467 CA Primary

Addresses

Primary practice location

31001 Rancho Viejo Rd #200
San Juan Capistrano, CA 92675

Mailing address

31001 Rancho Viejo Rd #200
San Juan Capistrano, CA 92675
Phone (949) 661-9600

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://memorialcare.org/fhir/api/FHIR/R4/ Health Information Exchange (HIE) MemorialCare Medical Foundation

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190415000163 CA Practitioner - Physician Assistant 9335480672 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Michael a Bain MD IncGroup PAC ID 4587761937, 2 clinicians

Practice addresses (Care Compare)

1501 Westcliff Dr
Suite 300
Newport Beach, CA 92660-5504
Phone (949) 720-0270

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.17 of 100Reported as group
Quality
81.15
Promoting interoperability
100
Improvement activities
40
Cost
71.64

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA56467CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Newport Beach Surgery Center, LLC CurrentSince Jan 1, 2021 Accepting new patients
Michael a Bain MD Inc CurrentSince Jan 1, 2021 Accepting new patients

Locations

1835 Newport Blvd
Ste A109404
Costa Mesa, CA 92627

1501 Westcliff Dr
Ste 300
Newport Beach, CA 92660
Phone (949) 720-0270

520 Superior Ave
Ste 360
Newport Beach, CA 92663
Phone (949) 644-1025

Organizations & group practices 3

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 3

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": "1548201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671148800000",
    "number": "1164986105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31001 RANCHO VIEJO RD #200",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "92675",
            "telephone_number": "949-661-9600",
            "fax_number": "949-443-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31001 RANCHO VIEJO RD #200",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "92675",
            "telephone_number": "949-661-9600",
            "fax_number": "949-443-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINCENT",
        "first_name": "JENNIFER",
        "middle_name": "BIANCA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-23",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA56467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://memorialcare.org/fhir/api/FHIR/R4/",
            "affiliation": "Y",
            "endpointDescription": "MemorialCare FHIR Endpoint",
            "affiliationName": "MemorialCare Medical Foundation",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "17360 Brookhurst St",
            "city": "Fountain Valley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "927083720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Juan Capistrano, CA

Sources for this page

Verify at the official NPI Registry.