Jeongsim Kim Izadi, RN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95016945 Issued in CA

Practice address

2814 Montair PL
Union City, CA 94587-1680

Phone

(510) 907-0014

NPI assigned

Oct 8, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jisadi128917@hpmg.direct-ci.net

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.

• Concertocare Medical Group of California, P.C.

  • Internal Medicine Physician
  • Huntington Beach, CA
  • NPI 1922777259
  Medicare reassignment NPD
• Majestic Palliative Care LLC

  • General Practice Physician
  • Morgan Hill, CA
  • NPI 1942075437
  Medicare reassignment NPD
• Hill Physicians Medical Group - PPO Program

  • Preferred Provider Organization
  • San Ramon, CA
  • NPI 1679011035
  NPD (past)
• Majestic Hospice & Home Health LLC

  • Community Based Hospice Care Agency
  • Morgan Hill, CA
  • NPI 1255847984
  NPD (past)

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

{
    "created_epoch": "1602115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629417600000",
    "number": "1639776933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2814 MONTAIR PL",
            "city": "UNION CITY",
            "state": "CA",
            "postal_code": "945871680",
            "telephone_number": "510-907-0014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2814 MONTAIR PL",
            "city": "UNION CITY",
            "state": "CA",
            "postal_code": "945871680",
            "telephone_number": "510-907-0014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IZADI",
        "first_name": "JEONGSIM",
        "middle_name": "KIM",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-08",
        "last_updated": "2021-08-20",
        "certification_date": "2021-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WH1000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Hospice",
            "state": "CA",
            "license": "D2102705",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95016945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Integral Home Health and Hospice Care LLC
• Integral Home Health LLC
• Tyler Anthony Intrieri
• Jennifer Nehama Isaacs, M.D.
• Tyrone Lee Isquirdo, D.C., Q.M.E.
• Jeremy Lazatin Jackson, MD
• Sue S. Jacobs, CNM
• Shuja Jafar-Ali, M.D.
• Jotika Jagasia
• Laurie Jaghab, PSY.D.

• Nurse Practitioner in Union City, CA
• Providers in Union City, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.