Individual provider Active NPI

Cornelius J.a. Jansen, MD

  • Otolaryngology Physician
  • Walnut Creek, CA
National Provider Identifier
1285712380
Registry record updated Oct 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
G85048 Issued in CA
Practice address
1425 S Main St
Walnut Creek, CA 94596-5318
Phone
(925) 295-4000
NPI assigned
Nov 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X G85048 CA Primary

Addresses

Primary practice location

1425 S Main St
Walnut Creek, CA 94596-5318

Mailing address

2390 Faraday Ave
Carlsbad, CA 92008-7216
Phone (510) 625-6262

Other identifiers 1

IdentifierTypeStateIssuer
00G850480MedicaidCA

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
I20110216001213 CA Practitioner - Otolaryngology 0345421897 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
85048CAMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California - Ucsd Medical Group CurrentSince May 1, 2023 Accepting new patients
Regents of the University of California Current Accepting new patients
Scripps Health Current Accepting new patients
Regents of the University of California CurrentSince May 1, 2023 Accepting new patients
Ritvik Mehta, MD Apc Otolaryngology CurrentSince Sep 11, 2019 Accepting new patients

Locations

2390 Faraday Ave
Carlsbad, CA 92008
Phone (858) 909-0770

577 Third Ave
Chula Vista, CA 91910
Phone (619) 426-5181

3855 Health Sciences Dr
La Jolla, CA 92093
Phone (858) 822-6094

9350 Campus Point Dr
La Jolla, CA 92037
Phone (858) 657-0583

9300 Campus Point Dr
La Jolla, CA 92037
Phone (619) 957-7000

9400 Campus Point Dr
La Jolla, CA 92093
Phone (858) 249-3800

5405 Oberlin Dr
Fl 2
San Diego, CA 92121
Phone (858) 279-4221

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

8899 University Center Ln
San Diego, CA 92122
Phone (858) 543-7496

16950 Via Tazon
San Diego, CA 92127
Phone (858) 521-2265

Interoperability endpoints

  • Direct secure messaging: cjansen324414@scrippshlth.medalliesdirect.net

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.

NPI Registry JSON

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570752000000",
    "number": "1285712380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2390 FARADAY AVE",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920087216",
            "telephone_number": "510-625-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 S MAIN ST",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945965318",
            "telephone_number": "925-295-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANSEN",
        "first_name": "CORNELIUS",
        "middle_name": "J.A.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2019-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "G85048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G850480",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.