Individual provider Active NPI

Jeri Lynn Ulberg, DC

  • Sports Physician Chiropractor
  • Thousand Oaks, CA
National Provider Identifier
1770612418
Registry record updated May 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
DC25942 Issued in CA
Practice address
901 Greenwich Dr.
Thousand Oaks, CA 91360
Phone
(805) 449-2646
Fax
(805) 449-2647
NPI assigned
Mar 5, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC25942 CA
Sports Physician Chiropractor 111NS0005X DC25942 CA Primary

Addresses

Primary practice location

901 Greenwich Dr.
Thousand Oaks, CA 91360

Mailing address

901 Greenwich Dr.
Thousand Oaks, CA 91360
Phone (805) 449-2646

Other identifiers 1

IdentifierTypeStateIssuer
0259420OtherCABLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040722001442 CA Practitioner - Chiropractic 4486634110 Reassigns benefits to 1 organization
Practice locations: Los Angeles, CA; Thousand Oaks, CA

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

901 Greenwich Dr
Thousand Oaks, CA 91360-6022
Phone (805) 449-2646

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC25942CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Ulberg Healing Choices & Chiropractic, Inc Sports Physician CurrentSince May 29, 2018 Accepting new patients

Locations

12764 W Washington Blvd
Los Angeles, CA 90066
Phone (818) 266-7599

762 Washington Blvd
Marina del Rey, CA 90292
Phone (818) 266-7599

Organizations & group practices 1

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": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525305600000",
    "number": "1770612418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 GREENWICH DR.",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "91360",
            "telephone_number": "805-449-2646",
            "fax_number": "805-449-2647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 GREENWICH DR.",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "91360",
            "telephone_number": "805-449-2646",
            "fax_number": "805-449-2647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ULBERG",
        "first_name": "JERI",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-05",
        "last_updated": "2018-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC25942",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "CA",
            "license": "DC25942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "0259420",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thousand Oaks, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.