Individual provider Active NPI

Jillian Alexandra Wesselman, NP

  • Nurse Practitioner
  • San Jose, CA
National Provider Identifier
1760972491
Registry record updated Jun 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95009247 Issued in CA
Practice address
2425 Samaritan Dr
San Jose, CA 95124
Phone
(408) 559-2011
NPI assigned
May 17, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 95059691 CA
Nurse Practitioner 363L00000X 95009247 CA Primary

Addresses

Primary practice location

2425 Samaritan Dr
San Jose, CA 95124

Mailing address

18085 Idalyn Dr
Los Gatos, CA 95033-8924
Phone (408) 204-0400

Other names 1

  • Miss Jillian Alexandra Goodwin Former name

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
I20180731002519 CA Practitioner - Nurse Practitioner 8123376647 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cep America - CaliforniaGroup PAC ID 6103739131, 1,278 clinicians

Practice addresses (Care Compare)

1555 Soquel Dr
Santa Cruz, CA 95065-1705
Phone (831) 462-7700

Merit-based Incentive Payment System (MIPS)

Final score
96.69 of 100Reported as group
Quality
90
Improvement activities
40
Cost
78.43

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
95059691CAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California CurrentSince Jul 1, 2018 Accepting new patients
Cep America - California Current Accepting new patients
Cep America-California CurrentSince Jul 1, 2018 Accepting new patients

Locations

2755 Herndon Ave
Clovis, CA 93611
Phone (559) 323-4000

2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

4445 Magnolia Ave
Riverside, CA 92501
Phone (800) 498-7156

2425 Samaritan Dr
San Jose, CA 95124
Phone (408) 354-2114

1555 Soquel Dr
Santa Cruz, CA 95065
Phone (831) 462-7700

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1526515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529539200000",
    "number": "1760972491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18085 IDALYN DR",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950338924",
            "telephone_number": "408-204-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 SAMARITAN DR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95124",
            "telephone_number": "408-559-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WESSELMAN",
        "first_name": "JILLIAN",
        "middle_name": "ALEXANDRA",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-17",
        "last_updated": "2018-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95059691",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95009247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILLIAN",
            "last_name": "GOODWIN",
            "middle_name": "ALEXANDRA",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.