Individual provider Active NPI

Jessica Maria Ekengren, D.C.

  • Chiropractor
  • Valencia, CA
National Provider Identifier
1528179447
Registry record updated Apr 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC27220 Issued in CA
Practice address
28212 Kelly Johnson Pkwy
Ste 120
Valencia, CA 91355-5085
Phone
(661) 254-9400
Fax
(661) 254-9495
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 28, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC27220 CA Primary

Addresses

Primary practice location

28212 Kelly Johnson Pkwy
Ste 120
Valencia, CA 91355-5085

Mailing address

28212 Kelly Johnson Pkwy
Ste 120
Valencia, CA 91355-5085
Phone (661) 254-9400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050131001095 CA Practitioner - Chiropractic 4981654530 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 1998
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

28212 Kelly Johnson Pkwy
Suite 120
Valencia, CA 91355-5085
Phone (661) 254-9400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC27220CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Ekengren Chiropractic Inc. Chiropractor CurrentSince Oct 28, 2012 Accepting new patients
PV Healthcare Corp CurrentSince Mar 1, 2020 Accepting new patients

Locations

28212 Kelly Johnson Pkwy
Ste 120
Valencia, CA 91355
Phone (661) 254-9400

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461801600000",
    "number": "1528179447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28212 KELLY JOHNSON PKWY",
            "address_2": "STE 120",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913555085",
            "telephone_number": "661-254-9400",
            "fax_number": "661-254-9495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28212 KELLY JOHNSON PKWY",
            "address_2": "STE 120",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913555085",
            "telephone_number": "661-254-9400",
            "fax_number": "661-254-9495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EKENGREN",
        "first_name": "JESSICA",
        "middle_name": "MARIA",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2016-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC27220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valencia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.