Active NPI
Jonathan Kern, MD
- Pediatrics Physician
- Sacramento, CA
National Provider Identifier
1215075205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- G52234
- Practice address
- 6600 Bruceville Rd
Sacramento, CA 95823-4671 - Phone
- (916) 688-2000
- NPI assigned
- Feb 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | G52234 | CA | Primary |
Addresses
Primary practice location
6600 Bruceville Rd
Sacramento, CA 95823-4671
Mailing address
1800 Harrison St FL 7
Oakland, CA 94612-3429
Phone (510) 625-6262
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G522340 | Medicaid | CA |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110126001091 | CA | Practitioner - Pediatric Medicine | 4880873546 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G52234 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regents of the Univ of Ca | Current | Accepting new patients | |
| Regents of the University of Ca | Pediatrics | Current | Accepting new patients |
| Regents of the Univ of Ca | Current | Accepting new patients | |
| Regents of the Univ of Ca | Past | Accepting new patients |
Locations
2521 Stockton Blvd
Ste 2200
Sacramento, CA 95817
Phone (916) 734-1180
4900 Broadway
Ste 2800
Sacramento, CA 95820
Phone (916) 734-9313
2521 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-1104
Organizations & group practices 4
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.
-
- Diagnostic Radiology Physician
- Sacramento, CA
- NPI 1477546406
-
- Pulmonary Disease Physician
- Sacramento, CA
- NPI 1437142692
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215075205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 HARRISON ST FL 7",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946123429",
"telephone_number": "510-625-6262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6600 BRUCEVILLE RD",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958234671",
"telephone_number": "916-688-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KERN",
"first_name": "JONATHAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "G52234",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G522340",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.