Individual provider Active NPI

Jennifer Decolongon, M.D.

  • Family Medicine Physician
  • Sacramento, CA
National Provider Identifier
1225344484
Registry record updated Dec 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A127594 Issued in CA
Practice address
1020 29TH St
Suite 480
Sacramento, CA 95816-5125
Phone
(916) 733-3777
Fax
(916) 454-6780
NPI assigned
Aug 26, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A127594 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X PENDING NY

Addresses

Primary practice location

1020 29TH St
Suite 480
Sacramento, CA 95816-5125

Mailing address

10470 Old Placerville Rd
Suite 100
Sacramento, CA 95827-2539
Phone (800) 470-0071

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
I20140423001143 CA Practitioner - Family Practice 0749413938 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
John Muir Physician NetworkGroup PAC ID 6608789813, 488 clinicians

Practice addresses (Care Compare)

2700 Grant St
Suite 200
Concord, CA 94520-2270
Phone (925) 674-0500

Hospital & facility affiliations

  • John Muir Medical Center - Walnut Creek Campus Hospital, Walnut Creek, CA, CCN 050180
  • John Muir Medical Center - Concord Campus Hospital, Concord, CA, CCN 050496

Merit-based Incentive Payment System (MIPS)

Final score
83.63 of 100Reported as group
Quality
67.56
Improvement activities
40
Cost
71.56

Merit-based Incentive Payment System (MIPS)

Final score
90.32 of 100Reported as group
Quality
89.54
Promoting interoperability
100
Improvement activities
40
Cost
74.34

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A127594CAMDFamily Medicine Physician
PENDINGNYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
John Muir Physician Network CurrentSince Sep 1, 2015 Accepting new patients
John Muir Trauma Physicians Billing Service Current Accepting new patients
John Muir Trauma Physicians Billing Service Family Medicine CurrentSince Mar 29, 2017 Accepting new patients
John Muir Health Past Accepting new patients
John Muir Health Past Accepting new patients

Locations

2400 Balfour Rd
Ste 120
Brentwood, CA 94513
Phone (925) 308-8112

2700 Grant St
Ste 200
Concord, CA 94520
Phone (925) 674-2609

2540 East St
Concord, CA 94520
Phone (925) 674-2228

380 Civic Dr
Ste 100
Pleasant Hill, CA 94523
Phone (925) 284-3840

1601 Ygnacio Valley Rd
Walnut Creek, CA 94598
Phone (925) 295-1545

1850 Mt Diablo Blvd
Ste 545
Walnut Creek, CA 94596
Phone (925) 946-1080

Interoperability endpoints

  • Direct secure messaging: jdecolongon40948@ehr.johnmuirhealth.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": "1282780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387324800000",
    "number": "1225344484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10470 OLD PLACERVILLE RD",
            "address_2": "SUITE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272539",
            "telephone_number": "800-470-0071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 29TH ST",
            "address_2": "SUITE 480",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958165125",
            "telephone_number": "916-733-3777",
            "fax_number": "916-454-6780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECOLONGON",
        "first_name": "JENNIFER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-26",
        "last_updated": "2013-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A127594",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": "PENDING",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.