Individual provider Active NPI

Jessica Fennewald, APRN

  • Adult Health Nurse Practitioner
  • Camarillo, CA
National Provider Identifier
1376856880
Registry record updated Jan 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
95007322 Issued in CA
Practice address
4005 Mission Oaks Blvd Ste a
Camarillo, CA 93012-5156
Phone
(805) 484-7921
Fax
(816) 478-7140
NPI assigned
Jul 26, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 95007322 CA Primary

Addresses

Primary practice location

4005 Mission Oaks Blvd Ste a
Camarillo, CA 93012-5156

Mailing address

4005 Mission Oaks Blvd Ste a
Camarillo, CA 93012-5156
Phone (805) 484-7921

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
I20180222001897 CA Practitioner - Nurse Practitioner 4981843281 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Genesis Healthcare Partners PCGroup PAC ID 2163606807, 232 clinicians

Practice addresses (Care Compare)

2241 Wankel Way
Suite a
Oxnard, CA 93030-0191
Phone (805) 983-0521

Hospital & facility affiliations

  • St Johns Regional Medical Center Hospital, Oxnard, CA, CCN 050082

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Healthcare Partners PC CurrentSince Oct 1, 2022 Accepting new patients
Gastroenterology & Hepatology Specialists Inc CurrentSince Jan 9, 2018 Accepting new patients
Genesis Healthcare Partners, PC PastSince Jan 12, 2025 Accepting new patients
Kansas City Health & Wellness Clinic, PA Past Accepting new patients
Sleepcair Past Accepting new patients

Locations

2241 Wankel Way
Ste A
Oxnard, CA 93030
Phone (805) 983-0521

50 Alessandro Pl
Ste 410
Pasadena, CA 91105
Phone (626) 793-7114

1687 Erringer Rd
Ste 103
Simi Valley, CA 93065
Phone (310) 927-1286

2060 E Avenida de los Arboles
Ste D
Thousand Oaks, CA 91362
Phone (805) 409-7290

Interoperability endpoints

  • Direct secure messaging: jessica.fennewald.1@3663.direct.athenahealth.com

Organizations & group practices 5

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 1

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": "1280102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737072000000",
    "number": "1376856880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4005 MISSION OAKS BLVD STE A",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930125156",
            "telephone_number": "805-484-7921",
            "fax_number": "816-478-7140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4005 MISSION OAKS BLVD STE A",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930125156",
            "telephone_number": "805-484-7921",
            "fax_number": "816-478-7140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENNEWALD",
        "first_name": "JESSICA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-26",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "95007322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Camarillo, CA

Sources for this page

Verify at the official NPI Registry.