Jeanette Rae Ponce, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A68979 Issued in CA

Practice address

2112 E 4TH St Ste 100
Santa Ana, CA 92705-3849

Phone

(714) 751-3800

Fax

(714) 795-2992

NPI assigned

Jan 24, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 11, 2019 through Jun 11, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Preventive Care Network Medical Services, Inc.

  dba James a Watson Wellness Center Medical Clinic

  • Specialist
  • Oakland, CA
  • NPI 1467878363
  NPD (past)

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543536000000",
    "number": "1548230337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 FRENCH STREET APT. C",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "92701",
            "telephone_number": "714-679-6584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2112 E 4TH ST STE 100",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927053849",
            "telephone_number": "714-751-3800",
            "fax_number": "714-795-2992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONCE",
        "first_name": "JEANETTE",
        "middle_name": "RAE",
        "name_prefix": "Ms.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-24",
        "last_updated": "2018-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A68979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A689790",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jan Elaine Pollitt, L.C.S.W.
• Adam Evan Pollock, PSY.D.
• Chiara Maria Polzonetti, LMFT #126322
• Amanda Pombar
• Paula Pompa-Craven, PSY.D.
• Yeymi Ponce
• Voranan Pongquan, NP
• Saowaree Ponrartana, MD
• Sornya Ponrartana, M.D.
• Patrick Christopher Poon, M.D.

• Family Medicine Physician in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.