Jackeline Lopez, AGNP- PCP, MSN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

95100221 Issued in CA

Practice address

1250 16TH St
Santa Monica, CA 90404-1249

Phone

(310) 825-9111

NPI assigned

Jul 10, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jackeline Arias Former name

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

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Our Family Medical Group IncGroup PAC ID 8729369665, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Our Family Medical Group, Inc.

  • Internal Medicine Physician
  • Rancho Cucamonga, CA
  • NPI 1437601879
  Medicare reassignment Care Compare group
• Our Family Medical Group, Inc.

  • Geriatric Medicine (Internal Medicine) Physician
  • Ontario, CA
  • NPI 1558068759
  NPD
• Our Family Medical Group, Inc.

  • Gastroenterology Physician
  • Chino, CA
  • NPI 1982419081
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1225875834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5594 VALENCIA DR",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917627648",
            "telephone_number": "760-217-9258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 16TH ST",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904041249",
            "telephone_number": "310-825-9111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "JACKELINE",
        "credential": "AGNP- PCP, MSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-10",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95100221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKELINE",
            "last_name": "ARIAS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sonja Nicole Loo, M.D.
• Jose Alejandro Lopez-Zavala, PTA
• Ana Luz Lopez, LCSW
• Bryan Lopez, M.D.
• Harlinah Katz Lopez, LCSW
• Leslie Karen Lopez
• Lidia Paola Lopez, APN-C
• Martha Lopez, MD
• Randy Lopez
• Raquel Lopez, PT

• Registered Nurse in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.