Jenna C Jorgensen

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A176988 Issued in CA

Practice address

401 Bicentennial Way
Santa Rosa, CA 95403-2149

Phone

(707) 393-4015

NPI assigned

Apr 11, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

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

Specialty

Family Practice

Education

University of Vermont College of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Willits Hospital IncGroup PAC ID 7416940697, 67 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Health Howard Memorial Hospital, Willits, CA, CCN 051310
• Adventist Health Ukiah Valley Hospital, Ukiah, CA, CCN 050301
• Adventist Health Mendocino Coast Hospital, Fort Bragg, CA, CCN 051325

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Willits Hospital Inc.

  • Critical Access Hospital
  • Willits, CA
  • NPI 1356339543
  Medicare reassignment Care Compare group NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299

  Family Medicine

  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1548343510

  Family Medicine

  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD
• Ukiah Adventist Hospital

  • Community/Retail Pharmacy
  • Willits, CA
  • NPI 1629432968
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Adventist Health Mendocino Coast

  • Critical Access Hospital
  • Fort Bragg, CA
  • NPI 1538113725
  Care Compare affiliation
• Ukiah Adventist Hospital

  • General Acute Care Hospital
  • Ukiah, CA
  • NPI 1235120676
  Care Compare affiliation
• Willits Hospital Inc.

  • Critical Access Hospital
  • Willits, CA
  • NPI 1356339543
  Care Compare affiliation

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

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652227200000",
    "number": "1831652254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 BICENTENNIAL WAY",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 BICENTENNIAL WAY",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032149",
            "telephone_number": "707-393-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORGENSEN",
        "first_name": "JENNA",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-11",
        "last_updated": "2022-05-11",
        "certification_date": "2022-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A176988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "401 Bicentennial Way",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954032149",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "401 Bicentennial Way",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954032149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Veronica Jordan, MD
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• Joseph L. Eliason, DDS, MSD, Apc
• David Joseph, PH.D.
• Dominique Patrice Joseph
• Matthew N. Joseph, MD
• Neha Joshi

• Family Medicine Physician in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2022; 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.
• 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.