NPIMap

Individual provider Active NPI

Jacqueline Marie Reardon, D.O.

  • Emergency Medicine Physician
  • Chula Vista, CA
National Provider Identifier
1417928557
Registry record updated Jul 31, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
20A10015 Issued in CA
Practice address
435 H St
Emergency Department
Chula Vista, CA 91910-4307
Phone
(619) 691-7290
NPI assigned
Jan 27, 2006
Last updated
Jul 31, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 20A10015 CA Primary
General Practice Physician 208D00000X 02002390A IN

Addresses

Primary practice location

435 H St
Emergency Department
Chula Vista, CA 91910-4307

Mailing address

435 H St
Emergency Department
Chula Vista, CA 91910-4307
Phone (619) 691-7290

Other names 1

  • Jacqueline Jones Former name

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
I20080623000467 CA Practitioner - Emergency Medicine 6305917113 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Philadelphia College of Osteopathic Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

678 3Rd Ave
Chula Vista, CA 91910-5736
Phone (619) 662-4100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.55 of 100Reported as group
Quality
86.53
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02002390AINMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Current Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. CurrentSince Dec 1, 2020 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro Inc CurrentSince Dec 1, 2020 Accepting new patients
Scripps Health Current Accepting new patients
Chula Vista Emergency Room Physicians, a Medical Corporation Emergency Medicine CurrentSince Dec 1, 2013 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Past Accepting new patients
Melvin a. Ochs, M.D., Medica Corp Emergency Medicine Past Accepting new patients

Locations

1637 Third Ave
Ste B
Chula Vista, CA 91911
Phone (619) 425-1780

333 H St
Ste 2080
Chula Vista, CA 91910

435 H St
Chula Vista, CA 91910
Phone (619) 691-7000

678 Third Ave
Chula Vista, CA 91910
Phone (619) 205-6349

1136 D Ave
National City, CA 91950
Phone (619) 336-2300

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: jreardon18686@syhealth.direct-ci.com
  • Direct secure messaging: jreardon28278@scrippshlth.medalliesdirect.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280534400000",
    "number": "1417928557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 H ST",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919104307",
            "telephone_number": "619-691-7290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 H ST",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919104307",
            "telephone_number": "619-691-7290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REARDON",
        "first_name": "JACQUELINE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-27",
        "last_updated": "2010-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "20A10015",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IN",
            "license": "02002390A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "JONES",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.