Individual provider Active NPI

Jennifer L Schroederus Kosloske, M.D.

  • Psychiatry Physician
  • Riverside, CA
National Provider Identifier
1912922360
Registry record updated Nov 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
C167499 Issued in CA
Practice address
5225 Canyon Crest Dr BLDG 100
Riverside, CA 92507-6301
Phone
(951) 248-4000
NPI assigned
Jul 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 44376-020 WI
Psychiatry Physician 2084P0800X C167499 CA Primary

Addresses

Primary practice location

5225 Canyon Crest Dr BLDG 100
Riverside, CA 92507-6301

Mailing address

10800 Magnolia Ave
Riverside, CA 92505-3043
Phone (951) 248-4000

Other identifiers 1

IdentifierTypeStateIssuer
34195600MedicaidWI

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 WI, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20051027000370 WI Practitioner - PsychiatryPractitioner - Geriatric Medicine 0749207942 Reassigns benefits to 1 organization
I20200518002445 CA Practitioner - Psychiatry 0749207942 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10800 Magnolia Ave
Riverside, CA 92505-3043
Phone (951) 353-2000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C167499CAMDPsychiatry Physician
44376-020WIMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cornerstone Counseling Services, Inc CurrentSince Jul 1, 2010 Accepting new patients
Southern California Permanente Medical Group CurrentSince Apr 27, 2020 Accepting new patients
Southern California Permanente Medical Group CurrentSince Apr 27, 2020 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Prohealth Medical Group Inc Past Accepting new patients
County of Milwaukee Psychiatry Past Accepting new patients

Locations

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

5225 Canyon Crest Dr
Bldg 100
Riverside, CA 92507
Phone (951) 248-4000

10800 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2000

16535 W Bluemound Rd
Ste 200
Brookfield, WI 53005
Phone (262) 789-0909

Organizations & group practices 6

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": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1912922360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10800 MAGNOLIA AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053043",
            "telephone_number": "951-248-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5225 CANYON CREST DR BLDG 100",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925076301",
            "telephone_number": "951-248-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHROEDERUS KOSLOSKE",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-13",
        "last_updated": "2021-11-29",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "44376-020",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "C167499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34195600",
            "state": "WI"
        }
    ],
    "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": "10800 Magnolia Ave",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925053043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.