Jennifer Jardeleza Crisostomo, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95019457 Issued in CA

Practice address

235 E Badillo St
Covina, CA 91723-2116

Phone

(626) 915-4700

Fax

(626) 214-7815

NPI assigned

Mar 18, 2022

Reactivated

May 4, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Foothill Cardiology Medical Group IncGroup PAC ID 8527049261, 36 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Huntington Hospital Hospital, Pasadena, CA, CCN 050438

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: jennifer.crisostomo.p166@direct.healthcarepartners.nextgenshare.com

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.

• Foothill Cardiology Medical Group Inc

  • Cardiovascular Disease Physician
  • Pasadena, CA
  • NPI 1255382545
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Pasadena Hospital Association, LTD

  • General Acute Care Hospital
  • Pasadena, CA
  • NPI 1407828429
  Care Compare affiliation

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

{
    "created_epoch": "1647561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1659020576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80011",
            "city": "CITY OF INDUSTRY",
            "state": "CA",
            "postal_code": "917168011",
            "telephone_number": "626-793-2885",
            "fax_number": "626-793-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 E BADILLO ST",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917232116",
            "telephone_number": "626-915-4700",
            "fax_number": "626-214-7815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRISOSTOMO",
        "first_name": "JENNIFER",
        "middle_name": "JARDELEZA",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-18",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "deactivation_date": "2022-03-18",
        "reactivation_date": "2022-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95019457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BRN",
            "identifier": "95019457",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AANPCB",
            "identifier": "F08210863",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Covina-Valley Unified School District
• Angie Craig, RN
• Creative Dental Arts, Inc.
• Creative Passion Partners Inc.
• Davon Crenshaw
• Jarrod Crist
• Cristine S. Zapanta DDS Inc
• Lori Ann Crosby
• Steven C Crum
• Kaylee Marie Cruthers

• Family Nurse Practitioner in Covina, CA
• Providers in Covina, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; 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.
• 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.