Individual provider Active NPI

Jennifer Huyen Macewan, M.D.

  • Otolaryngology Physician
  • Poway, CA
National Provider Identifier
1336382019
Registry record updated May 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
A113181 Issued in CA
Practice address
12630 Monte Vista Rd
Suite 206
Poway, CA 92064-2530
Phone
(858) 674-1165
Fax
(858) 312-1312
NPI assigned
Apr 11, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2018

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 A113181 CA Primary

Addresses

Primary practice location

12630 Monte Vista Rd
Suite 206
Poway, CA 92064-2530

Mailing address

12630 Monte Vista Rd
Suite 206
Poway, CA 92064-2530
Phone (858) 674-1165

Other names 1

  • Jennifer Huyen Ta Former name

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
I20150120001380 CA Practitioner - Otolaryngology 1951625029 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Eastern Virginia Medical School, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ashish K Wadhwa MD a Medical CorporationGroup PAC ID 9032167135, 3 clinicians

Practice addresses (Care Compare)

12630 Monte Vista Rd
Suite 206
Poway, CA 92064-2527
Phone (858) 674-1165

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A113181CAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ashish K Wadhwa MD a Medical Corporation Otolaryngology CurrentSince Mar 1, 2017 Accepting new patients
Palomar Health PastSince Mar 1, 2017 Accepting new patients

Locations

12630 Monte Vista Rd
Ste 206
Poway, CA 92064
Phone (858) 355-0244

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": "1239408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525132800000",
    "number": "1336382019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12630 MONTE VISTA RD",
            "address_2": "SUITE 206",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642530",
            "telephone_number": "858-674-1165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12630 MONTE VISTA RD",
            "address_2": "SUITE 206",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642530",
            "telephone_number": "858-674-1165",
            "fax_number": "858-312-1312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACEWAN",
        "first_name": "JENNIFER",
        "middle_name": "HUYEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-11",
        "last_updated": "2018-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "A113181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "TA",
            "middle_name": "HUYEN",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Poway, CA

Sources for this page

Verify at the official NPI Registry.