Jacqueline Idun, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95014031 Issued in CA

Practice address

2213 Buchanan Rd Ste 103
Antioch, CA 94509-4265

Phone

(925) 303-4780

NPI assigned

Feb 4, 2020

Sex

Female

Sole proprietor

No

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

State licenses

Practice roles

Locations

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.

• City & County of San Francisco

  • Clinical Medical Laboratory
  • San Francisco, CA
  • NPI 1982737524
  Medicare reassignment NPD
• City & County of San Francisco

  • Community Health/Public Health Clinical Nurse Specialist
  • San Francisco, CA
  • NPI 1609041060
  NPD
• City and County of San Francisco

  • Methadone Clinic
  • San Francisco, CA
  • NPI 1578787925
  NPD
• Bass Medical Group

  • Specialist
  • Walnut Creek, CA
  • NPI 1154401941
  NPD (past)

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

{
    "created_epoch": "1580774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586131200000",
    "number": "1659903045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2213 BUCHANAN RD STE 103",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945094265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2213 BUCHANAN RD STE 103",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945094265",
            "telephone_number": "925-303-4780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDUN",
        "first_name": "JACQUELINE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-04",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95071879",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95014031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlotte Hull, D.O.
• Lenny Husen, M.D
• Monica Huynh
• Ivan P Hwang, MD
• Erin Michelle Hyatt
• Catherine Ignacio
• Naoko Ikeda, DO
• Mariam Princess Ikharo-Matlock
• Raufat Habiba Ikharo-Umaru
• Samuel Inderias, MPT

• Family Nurse Practitioner in Antioch, CA
• Providers in Antioch, 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 Apr 6, 2020; 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.