Active NPI
Candice Michelle Jensen, M.D., PLLC
- Surgery Physician
- Yuma, AZ
National Provider Identifier
1346453990
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 38206
- Practice address
- 2503 S Ave a
Ste 3
Yuma, AZ 85364-7173 - Phone
- (928) 344-3250
- Fax
- (928) 344-3253
- NPI assigned
- May 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | A100498 | CA | |
| Surgery Physician | 208600000X | 38206 | AZ | Primary |
Addresses
Primary practice location
2503 S Ave a
Ste 3
Yuma, AZ 85364-7173
Mailing address
2503 S Ave a
Ste 3
Yuma, AZ 85364-7173
Phone (928) 344-3250
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0A1004980 | Medicaid | CA | |
| 340763 | Medicaid | AZ | |
| Z148161 | Other | AZ | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38206 | AZ | MD | Cardiovascular Disease Physician |
| A100498 | CA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329696000000",
"number": "1346453990",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2503 S AVE A",
"address_2": "STE 3",
"city": "YUMA",
"state": "AZ",
"postal_code": "853647173",
"telephone_number": "928-344-3250",
"fax_number": "928-344-3253"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2503 S AVE A",
"address_2": "STE 3",
"city": "YUMA",
"state": "AZ",
"postal_code": "853647173",
"telephone_number": "928-344-3250",
"fax_number": "928-344-3253"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENSEN",
"first_name": "CANDICE",
"middle_name": "MICHELLE",
"name_prefix": "Dr.",
"credential": "M.D., PLLC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-08",
"last_updated": "2012-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CA",
"license": "A100498",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "AZ",
"license": "38206",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0A1004980",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "340763",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "Z148161",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yuma, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.