Individual provider Active NPI

Jane Ellen Rodgers

  • Physician Assistant
  • Pomona, CA
National Provider Identifier
1235372145
Registry record updated Mar 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA15940 Issued in CA
Practice address
790 E Bonita Ave FL 2
Pomona, CA 91767-1906
Phone
(909) 447-8585
Fax
(909) 447-8593
NPI assigned
Apr 8, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2023

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 PA15940 CA Primary

Addresses

Primary practice location

790 E Bonita Ave FL 2
Pomona, CA 91767-1906

Mailing address

7300 Ranch Road 2222, Building 1, Ste 200
Austin, TX 78730
Phone (512) 628-0465

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, AZ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20100920000136 CA Practitioner - Physician Assistant 9739204363 Reassigns benefits to 3 organizations
I20230323002230 AZ Practitioner - Physician Assistant 9739204363 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Estrella Pkwy Medical Center LLCGroup PAC ID 6002067410, 6 clinicians

Practice addresses (Care Compare)

530 N Estrella Pkwy
Suite C1
Goodyear, AZ 85338-4138
Phone (623) 932-9211

Merit-based Incentive Payment System (MIPS)

Final score
82.18 of 100Reported as group
Quality
65.23
Promoting interoperability
100
Improvement activities
40
Cost
75.35

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9154AZMDDentist
PA15940CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Chaparral Medical Group Inc. CurrentSince May 24, 2010 Accepting new patients
Chaparral Medical Group, Inc. CurrentSince May 24, 2010 Accepting new patients
Chaparral Medical Group Inc. CurrentSince May 24, 2010 Accepting new patients
Pkwy Medical Center LLC Past Accepting new patients
Epiphany Dermatology PA Past Accepting new patients

Locations

1801 W Olympic Blvd
Pasadena, CA 91199

840 Towne Center Dr
Pomona, CA 91767

790 E Bonita Ave
Fl 2
Pomona, CA 91767
Phone (909) 447-8585

1866 N Orange Grove Ave
Ste 202
Pomona, CA 91767
Phone (909) 623-8796

9190 Haven Ave
Ste 101
Rancho Cucamonga, CA 91730
Phone (909) 581-6732

585 N Mountain Ave
Ste A
Upland, CA 91786
Phone (909) 608-7546

Interoperability endpoints

  • Direct secure messaging: jane.rodgers@epiphanyderm.emadirect.md

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1239148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679270400000",
    "number": "1235372145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 RANCH ROAD 2222, BUILDING 1, STE 200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78730",
            "telephone_number": "512-628-0465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 E BONITA AVE FL 2",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917671906",
            "telephone_number": "909-447-8585",
            "fax_number": "909-447-8593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODGERS",
        "first_name": "JANE",
        "middle_name": "ELLEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-08",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA15940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.