NPIMap

Individual provider Active NPI

Jessie M Piceno, MD

  • Nephrology Physician
  • Las Vegas, NV
National Provider Identifier
1578602579
Registry record updated Jul 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
14024 Issued in NV
Practice address
2820 W Charleston Blvd Ste 33
Las Vegas, NV 89102-1934
Phone
(702) 880-1558
NPI assigned
Feb 6, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 14024 NV Primary

Addresses

Primary practice location

2820 W Charleston Blvd Ste 33
Las Vegas, NV 89102-1934

Mailing address

2820 W Charleston Blvd Ste 33
Las Vegas, NV 89102-1934
Phone (702) 880-1558

Other practice location 1

600 Whitney Ranch Dr
Unit B11
Henderson, NV 89014-2611
Phone (702) 818-9246

Other practice location 2

3121 S Maryland Pkwy Ste 412
Las Vegas, NV 89109-2309
Phone (702) 997-4250

Other identifiers 2

IdentifierTypeStateIssuer
630186MedicaidAZ
1578602579MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110823000292 NV Practitioner - NephrologyPractitioner - Internal Medicine 6204006638 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Qazi Makhija and Barney LLPGroup PAC ID 5092717702, 12 clinicians

Practice addresses (Care Compare)

2820 W Charleston Blvd
Suite 33
Las Vegas, NV 89102-1934
Phone (702) 880-1558

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Qazi Makhija & Barney LLP Nephrology CurrentSince Mar 1, 2019 Accepting new patients
Dignity Health Past Accepting new patients
Kantor Nephrology Consultants, LTD Nephrology PastSince Dec 6, 2012 Accepting new patients
Desert Springs Hospital Past Accepting new patients
Las Vegas Kidney & Hypertension Specialists LLC Nephrology Past Accepting new patients

Locations

10301 Jeffreys St
Henderson, NV 89052
Phone (702) 269-0781

2820 W Charleston Blvd
Ste 33
Las Vegas, NV 89102
Phone (702) 388-4428

4424 S Eastern Ave
Las Vegas, NV 89119
Phone (702) 550-6868

2820 W Charleston Blvd
Ste B33
Las Vegas, NV 89102

3186 S Maryland Pkwy
Las Vegas, NV 89109
Phone (702) 731-8000

Interoperability endpoints

  • Direct secure messaging: jessie.piceno@direct.davitaphysiciansolutions.com

Organizations & group practices 5

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 12

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": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594166400000",
    "number": "1578602579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 W CHARLESTON BLVD STE 33",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021934",
            "telephone_number": "702-880-1558",
            "fax_number": "702-870-6821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 W CHARLESTON BLVD STE 33",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021934",
            "telephone_number": "702-880-1558"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Whitney Ranch Dr",
            "address_2": "Unit B11",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NV",
            "postal_code": "890142611",
            "country_code": "US",
            "telephone_number": "702-818-9246",
            "fax_number": "702-492-1728",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3121 S Maryland Pkwy Ste 412",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891092309",
            "country_code": "US",
            "telephone_number": "702-997-4250",
            "fax_number": "702-492-1728",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PICENO",
        "first_name": "JESSIE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-06",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NV",
            "license": "14024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630186",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1578602579",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.