NPIMap

Individual provider Active NPI

Grace H. Jeon, M.D.

  • Surgery Physician
  • Anaheim, CA
National Provider Identifier
1174521306
Registry record updated Oct 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
G84081 Issued in CA
Practice address
1211 W la Palma Ave Ste 705
Anaheim, CA 92801-2814
Phone
(714) 772-6701
Fax
(714) 772-5240
NPI assigned
Jul 12, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X G84081 CA Primary

Addresses

Primary practice location

1211 W la Palma Ave Ste 705
Anaheim, CA 92801-2814

Mailing address

1211 W la Palma Ave Ste 705
Anaheim, CA 92801-2814
Phone (714) 772-6701

Other identifiers 2

IdentifierTypeStateIssuer
00G840810MedicaidCA
G84081OtherCAMEDICAL LICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040317000603 CA Practitioner - General Surgery 7214827930 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Northwestern University Feinberg Medical School, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Anaheim Surgical AssociatesGroup PAC ID 1658309588, 3 clinicians

Practice addresses (Care Compare)

1211 W la Palma Ave
Suite 705
Anaheim, CA 92801-2814
Phone 7147726701104

Hospital & facility affiliations

  • Ahmc Anaheim Regional Medical Center Hospital, Anaheim, CA, CCN 050226

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair - groin (open)1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G84081CAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Good Samaritan Hospital, L.P. Past Accepting new patients
Pih Health Good Samaritan Hospital Past Accepting new patients
Usc Verdugo Hills Hospital, LLC Past Accepting new patients
University of California Irvine Past Accepting new patients
Providence Health System - Southern California Past Accepting new patients
Dignity Health Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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.

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": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1174521306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 W LA PALMA AVE STE 705",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928012814",
            "telephone_number": "714-772-6701",
            "fax_number": "714-772-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 W LA PALMA AVE STE 705",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928012814",
            "telephone_number": "714-772-6701",
            "fax_number": "714-772-5240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEON",
        "first_name": "GRACE",
        "middle_name": "H.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-12",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "G84081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G840810",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE NUMBER",
            "identifier": "G84081",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.