Individual provider Active NPI

Jessica Jorine Vaughn, DO

  • Pediatrics Physician
  • Santa Maria, CA
National Provider Identifier
1639691298
Registry record updated Nov 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
20A16893 Issued in CA
Practice address
235 S Palisade Dr
Santa Maria, CA 93454-5948
Phone
(805) 739-3561
Fax
(805) 739-3560
NPI assigned
Jul 14, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X 20A16893 CA Primary

Addresses

Primary practice location

235 S Palisade Dr
Santa Maria, CA 93454-5948

Mailing address

235 S Palisade Dr
Santa Maria, CA 93454-5948
Phone (805) 739-3561

Other practice location 1

2315 Stockton Blvd
Sacramento, CA 95817-2201
Phone (916) 734-2011

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230907003127 CA Practitioner - Pediatric Medicine 5193189207 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A16893CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Central Coast Health Centers Current Accepting new patients
Pacific Central Coast Health Centers CurrentSince Sep 18, 2023 Accepting new patients
Pacific Central Coast Health Centers CurrentSince Sep 18, 2023 Accepting new patients
Pacific Central Coast Health Centers Past Accepting new patients

Locations

500 Old River Rd
Ste 200
Bakersfield, CA 93311
Phone (661) 663-6429

235 S Palisade Dr
Santa Maria, CA 93454
Phone (805) 739-3561

1414 E Main St
Ste 201
Santa Maria, CA 93454
Phone (805) 739-3112

Interoperability endpoints

  • Direct secure messaging: jvaughn14996@valleychildrens-prd.direct-ci.com

Organizations & group practices 4

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": "1499990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699401600000",
    "number": "1639691298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 S PALISADE DR",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934545948",
            "telephone_number": "805-739-3561",
            "fax_number": "805-739-3560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 S PALISADE DR",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934545948",
            "telephone_number": "805-739-3561",
            "fax_number": "805-739-3560"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2315 Stockton Blvd",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958172201",
            "country_code": "US",
            "telephone_number": "916-734-2011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAUGHN",
        "first_name": "JESSICA",
        "middle_name": "JORINE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-14",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "20A16893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Maria, CA

Sources for this page

Verify at the official NPI Registry.