Jack R Watson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A65310 Issued in CA

Practice address

550 Water St Ste a
Santa Cruz, CA 95060-4126

Phone

(831) 425-0420

Fax

(831) 425-0185

NPI assigned

Sep 25, 2006

Sex

Male

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

Electronic endpoints 1

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

Specialty

Family PracticeAlso: Hospice/Palliative Care

Education

Medical College of Wisconsin, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hospice of Santa Cruz County Hospice, Scotts Valley, CA, CCN 051526
• Watsonville Community Hospital Hospital, Watsonville, CA, CCN 050194

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jack.watson.1@14789.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/7346/brand/1/csg/1/fhir/r4
• Direct secure messaging: jwatso88@yourcarecommunity.org

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Coastal Health Partners

  • Cardiovascular Disease Physician
  • Watsonville, CA
  • NPI 1437599032
  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1548343510

  Family Medicine

  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD
• Dignity Health

  • General Acute Care Hospital
  • Santa Cruz, CA
  • NPI 1427181007
  NPD (past)

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

• Hospice of Santa Cruz County

  • Community Based Hospice Care Agency
  • Scotts Valley, CA
  • NPI 1760454672
  Care Compare affiliation
• Pajaro Valley Health Care District Hospital Corporation

  • General Acute Care Hospital
  • Watsonville, CA
  • NPI 1619607488
  Care Compare affiliation

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1700986858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 WATER ST STE A",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950604126",
            "telephone_number": "831-425-0420",
            "fax_number": "831-425-0185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 WATER ST STE A",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950604126",
            "telephone_number": "831-425-0420",
            "fax_number": "831-425-0185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "JACK",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A65310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A653100",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0100850",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1931 Main St",
            "city": "Watsonville",
            "state": "CA",
            "country_code": "US",
            "postal_code": "950763027",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Melissa Waters, LVN
• Blake Watkins
• David A. Watkins, CMA
• Andria Katheryn Watson, NP, RN
• Crystal Lynn Watson
• Tamara Watson, M.D.
• Taylor Watson
• Christopher Wawrzyniak
• Pamela Diane Way, RN
• Kevin John Weatherwax

• Family Medicine Physician in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 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.
• 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.