Individual provider Active NPI

Jacqueline McKesey

  • Dermatology Physician
  • Chula Vista, CA
National Provider Identifier
1811422801
Registry record updated Jun 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
A178184 Issued in CA
Practice address
256 Landis Ave Ste 300
Chula Vista, CA 91910-2650
Phone
(619) 426-9600
Fax
(194) 264-1126
NPI assigned
Apr 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X A178184 CA
Pediatric Dermatology Physician 207NP0225X A178184 CA
Procedural Dermatology Physician 207NS0135X A178184 CA
Dermatology Physician 207N00000X A178184 CA Primary

Addresses

Primary practice location

256 Landis Ave Ste 300
Chula Vista, CA 91910-2650

Mailing address

256 Landis Ave Ste 300
Chula Vista, CA 91910-2650
Phone (619) 426-9600

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220829001361 CA Practitioner - Dermatology 1951785781 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Georgetown University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Bay Skin and Cancer Medical Group IncGroup PAC ID 1153399258, 3 clinicians

Practice addresses (Care Compare)

256 Landis Ave
FL 3
Chula Vista, CA 91910-2650
Phone (619) 426-9600

Merit-based Incentive Payment System (MIPS)

Final score
92.61 of 100Reported as individual
Quality
92.55
Promoting interoperability
85
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision32
Removal of tissue43
Removal of skin lesions1466
Removal of skin cancer72
Skin biopsy336

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A178184CAMDProcedural Dermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Bay Skin & Cancer Medical Group, Inc. Dermatology CurrentSince Aug 1, 2022 Accepting new patients
Scripps Health PastSince Jun 23, 2024 Accepting new patients

Locations

256 Landis Ave
Fl 3
Chula Vista, CA 91910
Phone (619) 426-9600

256 Landis Ave
Ste 300
Chula Vista, CA 91910
Phone (619) 422-1233

1222 1st St
Ste 100
Coronado, CA 92118

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: jmckesey68316@direct.phhs.org

Organizations & group practices 2

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": "1493251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718755200000",
    "number": "1811422801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "256 LANDIS AVE STE 300",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919102650",
            "telephone_number": "619-426-9600",
            "fax_number": "619-543-6529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "256 LANDIS AVE STE 300",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919102650",
            "telephone_number": "619-426-9600",
            "fax_number": "194-264-1126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKESEY",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-27",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "A178184",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "CA",
            "license": "A178184",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "A178184",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A178184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.