Jennifer Moreno Prior, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

4455 W 117TH St
#300
Hawthorne, CA 90250

Phone

(310) 645-0444

Fax

(310) 978-0599

NPI assigned

May 29, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northeast Community Clinic

  dba Wilmington Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Wilmington, CA
  • NPI 1700097540
  Medicare reassignment
• Northeast Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Hawthorne, CA
  • NPI 1275226334
  NPD
• Northeast Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Bell, CA
  • NPI 1366957508

  Physician Assistant

  NPD

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

{
    "created_epoch": "1401321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530748800000",
    "number": "1821400490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4455 W 117TH ST STE 300",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902502240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 W 117TH ST",
            "address_2": "#300",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "90250",
            "telephone_number": "310-645-0444",
            "fax_number": "310-978-0599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIOR",
        "first_name": "JENNIFER",
        "middle_name": "MORENO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-29",
        "last_updated": "2018-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edelmira Portillo
• Yesenia Portillo, NP
• Sheila Powell
• Preferred Therapy Associates, Inc
• Primax Healthcare Associates, Inc.
• Psychiatric Excellence
• Jordyn Pursel, OT
• Eugene Pylen, DDS
• Quantum Rehabcare PC (Quantum Rehabcare)
• Sharmila Quenimherr, M.S.

• Physician Assistant in Hawthorne, CA
• Providers in Hawthorne, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.