NPIMap

Individual provider Active NPI

Jenna Rose Gharzeddine, MD

  • Internal Medicine Physician
  • Simi Valley, CA
National Provider Identifier
1356827323
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
160972 Issued in CA
Practice address
2876 Sycamore Dr Ste 101
Simi Valley, CA 93065-1550
Phone
(805) 527-6424
NPI assigned
Jul 12, 2018
Last updated
Oct 30, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Internal Medicine Physician 207R00000X 160972 CA Primary

Addresses

Primary practice location

2876 Sycamore Dr Ste 101
Simi Valley, CA 93065-1550

Mailing address

1720 E Cesar E Chavez Ave
Los Angeles, CA 90033-2414
Phone (323) 268-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191218000607 CA Practitioner - Internal Medicine 4789018102 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

124 Macaw LN
Simi Valley, CA 93065-3152
Phone (805) 306-0304

2950 Sycamore Dr
Simi Valley, CA 93065-1210

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.77 of 100Reported as apm
Quality
81.54
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
160972CAMDPharmacy Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Physicians Network Internal Medicine Current Accepting new patients
Adventist Health Physicians Network CurrentSince Apr 1, 2020 Accepting new patients
Adventist Health Physicians Network CurrentSince Apr 1, 2020 Accepting new patients
Simi Valley Hospital and Health Care Services Past Accepting new patients

Locations

124 Macaw Ln
Simi Valley, CA 93065
Phone (805) 306-0304

2876 Sycamore Dr
Ste 101
Simi Valley, CA 93065
Phone (805) 527-6424

2950 Sycamore Dr
Ste 200
Simi Valley, CA 93065
Phone (661) 705-9706

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1531353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1356827323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 E CESAR E CHAVEZ AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332414",
            "telephone_number": "323-268-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2876 SYCAMORE DR STE 101",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651550",
            "telephone_number": "805-527-6424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHARZEDDINE",
        "first_name": "JENNA",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-12",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "160972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Simi Valley, CA

Sources for this page

Verify at the official NPI Registry.