Jamie Pivonka-Jones, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

2195 Club Center Dr Ste a
San Bernardino, CA 92408-4162

Phone

(909) 835-1899

NPI assigned

Mar 23, 2007

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 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

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  NPD

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1881711901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2195 CLUB CENTER DR STE A",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924084162",
            "telephone_number": "909-835-1899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2195 CLUB CENTER DR STE A",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924084162",
            "telephone_number": "909-835-1899"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21810 Normandie Ave",
            "address_purpose": "LOCATION",
            "city": "Torrance",
            "state": "CA",
            "postal_code": "905022047",
            "country_code": "US",
            "telephone_number": "310-783-4677 x4252",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PIVONKA-JONES",
        "first_name": "JAMIE",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-23",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "23181",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "EPIC",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2195 Club Center Dr Ste A",
            "city": "San Bernardino",
            "state": "CA",
            "country_code": "US",
            "postal_code": "924084162",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Psychologist in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; 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.