Individual provider Active NPI

Jodie A Escobedo, M.D.

  • Family Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1851346084
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G80677 Issued in CA
Practice address
2143 S Sepulveda Blvd
300
Los Angeles, CA 90025-5733
Phone
(310) 575-3100
Fax
(310) 575-3102
NPI assigned
May 24, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G80677 CA Primary

Addresses

Primary practice location

2143 S Sepulveda Blvd
300
Los Angeles, CA 90025-5733

Mailing address

2143 S Sepulveda Blvd
300
Los Angeles, CA 90025-5733
Phone (310) 575-3100

Other identifiers 1

IdentifierTypeStateIssuer
GR0091750MedicaidCA

Other names 1

  • Mrs. Jodie Annroe Escobedo Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20081208000632 CA Practitioner - Family PracticePractitioner - Addiction Medicine 5991718405 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Washington University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

25821 Vermont Ave
Harbor City, CA 90710-3518
Phone (310) 325-5111

25825 Vermont Ave
Harbor City, CA 90710-3518
Phone (310) 325-5111

25965 Normandie Ave
Harbor City, CA 90710-3416
Phone (310) 325-5111

25975 Normandie Ave
Harbor City, CA 90710-3416
Phone (310) 257-6115

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G80677CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Dec 23, 2014 Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 23, 2014 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

9333 Rosecrans Ave
Bellflower, CA 90706
Phone (562) 461-3340

25825 Vermont Ave
Harbor City, CA 90710
Phone (310) 325-5111

6041 Cadillac Ave
Los Angeles, CA 90034
Phone (323) 857-2000

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

Organizations & group practices 3

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": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1851346084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2143 S SEPULVEDA BLVD",
            "address_2": "300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900255733",
            "telephone_number": "310-575-3100",
            "fax_number": "310-575-3102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2143 S SEPULVEDA BLVD",
            "address_2": "300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900255733",
            "telephone_number": "310-575-3100",
            "fax_number": "310-575-3102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ESCOBEDO",
        "first_name": "JODIE",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-24",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G80677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0091750",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "25825 Vermont Ave",
            "city": "Harbor City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "907103518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JODIE",
            "last_name": "ESCOBEDO",
            "middle_name": "ANNROE",
            "prefix": "MRS.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.