Jenny Elizabeth Nichols, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY29243 Issued in CA

Practice address

1660 E Roseville Pkwy
Roseville, CA 95661-3988

Phone

(167) 844-0009

Fax

(877) 738-4262

NPI assigned

Jan 17, 2018

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

• Jenny E Imberi Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Richmond, CA
  • NPI 1235226531
  NPD

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

{
    "created_epoch": "1516147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641859200000",
    "number": "1316455926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 E ROSEVILLE PKWY",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613988",
            "telephone_number": "167-844-0009",
            "fax_number": "877-738-4262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 E ROSEVILLE PKWY",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956613988",
            "telephone_number": "167-844-0009",
            "fax_number": "877-738-4262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "JENNY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-17",
        "last_updated": "2022-01-11",
        "certification_date": "2021-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY29243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1680 E Roseville Pkwy Bldg D",
            "city": "Roseville",
            "state": "CA",
            "country_code": "US",
            "postal_code": "956613988",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNY",
            "last_name": "IMBERI",
            "middle_name": "E",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Viet Huu Nguyen
• Vu Nguyen, OD
• Vy Nguyen
• Yen Nguyen I
• Adeline Nibitanga
• Jordanne Grace Nichols, DO
• Judith Ann Nichols, C.N.M, N.P.
• Paul Nichols
• Vanessa Nicholson, PSYD
• Terri Lee Nickell, DPT

• Clinical Psychologist in Roseville, CA
• Providers in Roseville, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.