Individual provider Active NPI

Jane Petersen, AUDIOLOGIST

  • Audiologist
  • La Mesa, CA
National Provider Identifier
1811618986
Registry record updated Sep 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
1081 Issued in CA
Practice address
5020 Baltimore Dr Ste a
La Mesa, CA 91942-0692
Phone
(619) 460-0180
NPI assigned
Sep 7, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 1081 CA Primary

Addresses

Primary practice location

5020 Baltimore Dr Ste a
La Mesa, CA 91942-0692

Mailing address

5020 Baltimore Dr Ste a
La Mesa, CA 91942-0692
Phone (619) 460-0180

Other practice location 1

7420 Clairemont Mesa Blvd Ste 119
San Diego, CA 92111-1546
Phone (619) 460-0180

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
1081CAMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Carpadakis Hearing, Inc CurrentSince Sep 11, 2022 Accepting new patients
Carpadakis Hearing, Inc CurrentSince Sep 4, 2022 Accepting new patients

Locations

5020 Baltimore Dr
Ste A
La Mesa, CA 91942
Phone (619) 460-0180

7420 Clairemont Mesa Blvd
Ste 119
San Diego, CA 92111
Phone (619) 460-0180

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": "1662508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662508800000",
    "number": "1811618986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5020 BALTIMORE DR STE A",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919420692",
            "telephone_number": "619-460-0180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5020 BALTIMORE DR STE A",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919420692",
            "telephone_number": "619-460-0180"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7420 Clairemont Mesa Blvd Ste 119",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921111546",
            "country_code": "US",
            "telephone_number": "619-460-0180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JANE",
        "credential": "AUDIOLOGIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-07",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "CA",
            "license": "1081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.