Individual provider Active NPI

Jennifer T Dixon, ANP-BC

  • Adult Health Nurse Practitioner
  • Northridge, CA
National Provider Identifier
1538430418
Registry record updated Jan 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
21271 Issued in CA
Practice address
8510 Balboa Blvd
Suite 150
Northridge, CA 91325-3583
Phone
(818) 637-2000
Fax
(818) 933-0549
NPI assigned
Jan 24, 2012
Last updated
Jan 24, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2012

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 738910 CA
Adult Health Nurse Practitioner 363LA2200X 21271 CA Primary

Addresses

Primary practice location

8510 Balboa Blvd
Suite 150
Northridge, CA 91325-3583

Mailing address

8510 Balboa Blvd
Suite 150
Northridge, CA 91325-3583
Phone (818) 637-2000

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
I20120509000700 CA Practitioner - Nurse Practitioner 1456513373 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
738910CAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeside Medical Organization, a Medical Group Inc. CurrentSince Mar 4, 2012 Accepting new patients
Lakeside Medical Associates, a Medical Group, Inc. Past Accepting new patients

Locations

191 S Buena Vista St
Ste 200
Burbank, CA 91505
Phone (818) 887-2671

8510 Balboa Blvd
Ste 150
Northridge, CA 91325
Phone (818) 637-2000

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: jennifer.dixon.p1@direct.lakeside.nextgenshare.com

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": "1327363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327363200000",
    "number": "1538430418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8510 BALBOA BLVD",
            "address_2": "SUITE 150",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913253583",
            "telephone_number": "818-637-2000",
            "fax_number": "818-933-0549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8510 BALBOA BLVD",
            "address_2": "SUITE 150",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913253583",
            "telephone_number": "818-637-2000",
            "fax_number": "818-933-0549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIXON",
        "first_name": "JENNIFER",
        "middle_name": "T",
        "name_prefix": "Ms.",
        "credential": "ANP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-24",
        "last_updated": "2012-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "738910",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "21271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northridge, CA

Sources for this page

Verify at the official NPI Registry.