Individual provider Active NPI

Jacqueline Ovsepyan

  • Primary Care Nurse Practitioner
  • Los Angeles, CA
National Provider Identifier
1639782501
Registry record updated Jul 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
95016443 Issued in CA
Practice address
808 W 58TH St FL 2
Los Angeles, CA 90037-3632
Phone
(323) 541-1600
NPI assigned
Aug 28, 2020
Last updated
Jul 16, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 16, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 95016443 CA Primary
Emergency Registered Nurse 163WE0003X 833253 CA

Addresses

Primary practice location

808 W 58TH St FL 2
Los Angeles, CA 90037-3632

Mailing address

808 W 58TH St FL 2
Los Angeles, CA 90037-3632
Phone (323) 541-1600

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210524002796 CA Practitioner - Nurse Practitioner 4385043371 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. John's Community HealthGroup PAC ID 2961482690, 151 clinicians

Practice addresses (Care Compare)

1910 Magnolia Ave
Suite 101
Los Angeles, CA 90007-1220
Phone (213) 749-0947

2115 N Wilmington Ave
Compton, CA 90222-2030
Phone (310) 603-1332

5701 S Hoover St
Los Angeles, CA 90037-4045
Phone (323) 541-1411

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Minuteclinic Diagnostic Medical Group of California Inc CurrentSince Apr 6, 2021 Accepting new patients
St. Johns Community Health CurrentSince Jul 23, 2021 Accepting new patients
St. Johns Community Health Current Accepting new patients
Minuteclinic Diagnostic Medical Group of Orange County Inc CurrentSince Apr 6, 2021 Accepting new patients
Minuteclinic Diagnostic Medical Group of San Diego Inc CurrentSince Apr 6, 2021 Accepting new patients
St. Johns Community Health CurrentSince Jul 23, 2021 Accepting new patients
St. Johns Community Health Past Accepting new patients

Locations

1401 S Baldwin Ave
Arcadia, CA 91007
Phone (626) 321-4210

2115 N Wilmington Ave
Compton, CA 90222
Phone (310) 603-1332

2760 Fletcher Pkwy
El Cajon, CA 92020
Phone (619) 461-4411

987 E Hillsdale Blvd
Foster City, CA 94404
Phone (650) 570-4631

11428 Kenyon Way
Rancho Cucamonga, CA 91701
Phone (909) 589-4098

1350 Florin Rd
Sacramento, CA 95822
Phone (916) 392-5184

1900 19th Ave
San Francisco, CA 94116
Phone (415) 664-1834

2514 Berryessa Rd
San Jose, CA 95132
Phone (408) 272-1431

2455 San Ramon Valley Blvd
San Ramon, CA 94583
Phone (925) 820-7325

921 Pacific Coast Hwy
Seal Beach, CA 90740
Phone (562) 598-0473

33205 US Highway 79
Temecula, CA 92592
Phone (951) 303-3154

2791 Agoura Rd
Westlake Village, CA 91361
Phone (800) 523-4042

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: jacqueline.ovsepyan@sjch.eclinicaldirectplus.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1598572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626393600000",
    "number": "1639782501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 W 58TH ST FL 2",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900373632",
            "telephone_number": "323-541-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 W 58TH ST FL 2",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900373632",
            "telephone_number": "323-541-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OVSEPYAN",
        "first_name": "JACQUELINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-28",
        "last_updated": "2021-07-16",
        "certification_date": "2021-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "95016443",
            "primary": true
        },
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "CA",
            "license": "833253",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.