Individual provider Active NPI

Jennifer Maholchic, PA-C

  • Physician Assistant
  • Mission Viejo, CA
National Provider Identifier
1306622774
Registry record updated Nov 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
63182 Issued in CA
Practice address
26401 Crown Valley Pkwy Ste 101
Mission Viejo, CA 92691-6302
Phone
(949) 348-4000
NPI assigned
Sep 1, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2024

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 63182 CA Primary

Addresses

Primary practice location

26401 Crown Valley Pkwy Ste 101
Mission Viejo, CA 92691-6302

Mailing address

16055 Ventura Blvd Ste 444
Encino, CA 91436-2608

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231204001687 CA Practitioner - Physician Assistant 6305294208 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Orthopedic Medical GroupGroup PAC ID 2365426517, 17 clinicians

Practice addresses (Care Compare)

26401 Crown Valley Pkwy
Suite 101
Mission Viejo, CA 92691-6302
Phone (949) 348-4000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
63182CAMDPharmacist

Organizations & group practices 2

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": "1693526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1306622774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16055 VENTURA BLVD STE 444",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26401 CROWN VALLEY PKWY STE 101",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916302",
            "telephone_number": "949-348-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHOLCHIC",
        "first_name": "JENNIFER",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-09-01",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "63182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mission Viejo, CA

Sources for this page

Verify at the official NPI Registry.