Individual provider Active NPI

Jacquelyn Becerra

  • Certified Registered Nurse Anesthetist
  • San Diego, CA
National Provider Identifier
1548683402
Registry record updated Mar 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
95055880 Issued in CA
Practice address
200 W Arbor Dr
San Diego, CA 92103-9000
Phone
(800) 926-8273
NPI assigned
Jan 29, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 041416690 IL
Certified Registered Nurse Anesthetist 367500000X 95000293 CA
Certified Registered Nurse Anesthetist 367500000X 95055880 CA Primary

Addresses

Primary practice location

200 W Arbor Dr
San Diego, CA 92103-9000

Mailing address

PO Box 232410
San Diego, CA 92193-2410

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140521000236 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 2062635006 Reassigns benefits to 2 organizations
I20151103000973 CA Practitioner - Certified Registered Nurse Anesthetist (Crna) 2062635006 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northstar Anesthesia of Illinois, LLCGroup PAC ID 4688893878, 404 clinicians
Midwest Anesthesia Partners LLCGroup PAC ID 6204737596, 117 clinicians

Practice addresses (Care Compare)

120 N Oak St
Hinsdale, IL 60521-3829
Phone (630) 856-9000

1423 Chicago Rd
Chicago Heights, IL 60411-3400
Phone (708) 756-1000

5101 Willow Springs Rd
La Grange, IL 60525-2600
Phone (708) 352-1200

Hospital & facility affiliations

  • Uchicago Medicine Adventhealth Hinsdale Hospital, Hinsdale, IL, CCN 140122
  • Uchicago Medicine Adventhealth la Grange Hospital, La Grange, IL, CCN 140065
  • Uchicago Medicine Adventhealth Bolingbrook Hospital, Bolingbrook, IL, CCN 140304

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
95000293CAMDFamily Nurse Practitioner
95055880CAMDCertified Registered Nurse Anesthetist
041416690ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Northstar Anesthesia of Illinois, LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2026 Accepting new patients
Martin Luther King Jr Community Medical Foundation CurrentSince Nov 1, 2018 Accepting new patients
Midwest Anesthesia Partners, LLC CurrentSince Oct 22, 2023 Accepting new patients
Regents of the University of California CurrentSince Feb 8, 2021 Accepting new patients
Tower Anesthesia Associates Inc CurrentSince Jul 2, 2019 Accepting new patients
Regents of the University of California Nurse Anesthetist, Certified Registered CurrentSince Feb 18, 2021 Accepting new patients
Martin Luther King Jr Community Medical Foundation CurrentSince Nov 1, 2018 Accepting new patients
Regents of the University of California CurrentSince Feb 8, 2021 Accepting new patients
Martin Luther King Jr Community Medical Foundation Current Accepting new patients
Windy City Anesthesia PC Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

9090 Wilshire Blvd
Ste 101
Beverly Hills, CA 90211
Phone (310) 421-0066

2215 W Rosecrans Ave
Ste 22
Compton, CA 90222
Phone (424) 529-6755

5 Holland
Ste 101
Irvine, CA 92618
Phone (949) 588-2199

1680 E 120th St
Los Angeles, CA 90059
Phone (424) 338-8000

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

2900 N Lakeshore
Chicago, IL 60657
Phone (773) 665-3240

7435 W Talcott Ave
Chicago, IL 60631
Phone (773) 467-9977

387 Shuman Blvd
Ste 240W
Naperville, IL 60563

120 N Oak St
Oak Brook Mall, IL 60521
Phone (630) 856-6700

1423 Chicago Rd
Sauk Village, IL 60411
Phone (708) 679-2160

Organizations & group practices 10

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.

Hospital & facility affiliations 5

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": "1390953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1548683402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 232410",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921932410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W ARBOR DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921039000",
            "telephone_number": "800-926-8273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BECERRA",
        "first_name": "JACQUELYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-29",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "041416690",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CA",
            "license": "95000293",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CA",
            "license": "95055880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; 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.