Individual provider Active NPI

Julie Chrisco

  • Primary Care Nurse Practitioner
  • San Diego, CA
National Provider Identifier
1528476256
Registry record updated Jun 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
95000961 Issued in CA
Practice address
2365 Northside Dr
Suite 100
San Diego, CA 92108-2709
Phone
(855) 848-5433
Fax
(888) 971-4283
NPI assigned
Jul 25, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 95000961 CA Primary

Addresses

Primary practice location

2365 Northside Dr
Suite 100
San Diego, CA 92108-2709

Mailing address

2365 Northside Dr
Suite 100
San Diego, CA 92108-2709
Phone (855) 848-5433

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211001002824 CA Practitioner - Nurse Practitioner 7113206954 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1200 Discovery Dr
Bakersfield, CA 93309-7032
Phone (661) 328-9831

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95000961CAMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Jun 24, 2023 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jun 24, 2023 Accepting new patients

Locations

3733 San Dimas St
Bakersfield, CA 93301
Phone (661) 631-3008

3733 San Dimas St
Ste 101
Bakersfield, CA 93301
Phone (800) 353-5400

1200 Discovery Dr
Bakersfield, CA 93309
Phone (661) 328-9831

Organizations & group practices 3

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": "1406246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1528476256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2365 NORTHSIDE DR",
            "address_2": "SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921082709",
            "telephone_number": "855-848-5433",
            "fax_number": "888-971-4283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2365 NORTHSIDE DR",
            "address_2": "SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921082709",
            "telephone_number": "855-848-5433",
            "fax_number": "888-971-4283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHRISCO",
        "first_name": "JULIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-25",
        "last_updated": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "95000961",
            "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": "3733 San Dimas St",
            "city": "Bakersfield",
            "state": "CA",
            "country_code": "US",
            "postal_code": "933011407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.