Individual provider Active NPI

Jessica Lynn Momberg, CNM

  • Advanced Practice Midwife
  • Oceanside, CA
National Provider Identifier
1386046266
Registry record updated Oct 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
236132 Issued in CA
Practice address
2210 Mesa Dr Ste 5
Oceanside, CA 92054-3701
Phone
(760) 736-6767
NPI assigned
Sep 22, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 673061 NY
Advanced Practice Midwife 367A00000X 236132 CA Primary

Addresses

Primary practice location

2210 Mesa Dr Ste 5
Oceanside, CA 92054-3701

Mailing address

PO Box 232410
San Diego, CA 92193-2410

Other practice location 1

200 W Arbor Dr
San Diego, CA 92103-9000
Phone (800) 926-8273

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200915003142 CA Practitioner - Certified Nurse Midwife (CNM) 8527356500 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
001662NYMDSpecialist
236132CAMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California CurrentSince Dec 10, 2021 Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 9, 2023 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc CurrentSince Jun 27, 2022 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 9, 2023 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc CurrentSince Jun 27, 2022 Accepting new patients
Regents of the University of California Advanced Practice Midwife CurrentSince Dec 10, 2021 Accepting new patients

Locations

393 E Walnut St
Fl 5
Pasadena, CA 91188
Phone (310) 403-3235

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

2020 Genesee Ave
San Diego, CA 92123
Phone (619) 268-9500

2929 Health Center Dr
San Diego, CA 92123
Phone (858) 939-6531

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

150 Valpreda Rd
San Marcos, CA 92069
Phone (619) 736-6700

Interoperability endpoints

  • Direct secure messaging: jmomberg563640@nychhc.direct-ci.com

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1411344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1386046266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 232410",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921932410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2210 MESA DR STE 5",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920543701",
            "telephone_number": "760-736-6767"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 W Arbor Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921039000",
            "country_code": "US",
            "telephone_number": "800-926-8273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOMBERG",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "CNM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-22",
        "last_updated": "2023-10-27",
        "certification_date": "2022-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "673061",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "CA",
            "license": "236132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Oceanside, CA

Sources for this page

Verify at the official NPI Registry.