NPIMap

Individual provider Active NPI

Jacqueline A Eubany, M.D.

  • Clinical Cardiac Electrophysiology Physician
  • Orange, CA
National Provider Identifier
1912986944
Registry record updated Sep 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
70735 Issued in MN
Practice address
438 E Katella Ave Ste B
Orange, CA 92867-4857
Phone
(714) 744-5000
Fax
(714) 744-5985
NPI assigned
Jan 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2023

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 0101242737 VA
Clinical Cardiac Electrophysiology Physician 207RC0001X MED-PHYS-LIC-129127 MT
Clinical Cardiac Electrophysiology Physician 207RC0001X 10038A WY
Clinical Cardiac Electrophysiology Physician 207RC0001X A134183 CA
Clinical Cardiac Electrophysiology Physician 207RC0001X 81736-20 WI
Clinical Cardiac Electrophysiology Physician 207RC0001X 70735 MN Primary

Addresses

Primary practice location

438 E Katella Ave Ste B
Orange, CA 92867-4857

Mailing address

438 E Katella Ave Ste B
Orange, CA 92867-4857
Phone (714) 744-5000

Other practice location 1

801 N Tustin Ave Ste 706
Santa Ana, CA 92705-3611
Phone (714) 568-6600

Other practice location 2

1802 Braeburn Dr
Salem, VA 24153-7357
Phone (540) 772-3815

Other practice location 3

700 S Park St Ste A
Madison, WI 53715-1830
Phone (608) 260-2900

Other practice location 4

500 W Broadway St
Missoula, MT 59802-4008
Phone (406) 329-5615

Other identifiers 1

IdentifierTypeStateIssuer
1912986944MedicaidWI

Electronic endpoints 4

TypeEndpointUseAffiliation
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
Direct Messaging Address jeubany299545@direct.myadvocateaurora.org Direct
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other
Direct Messaging Address jeubany446511@direct-ehr-ssmhc.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, IA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150428000723 CA Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology) 6204882277 Reassigns benefits to 2 organizations
I20260622003544 IA Practitioner - Cardiovascular Disease (Cardiology) 6204882277 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac ElectrophysiologyAlso: Cardiovascular Disease (Cardiology)
Education
Boston University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prohealth Partners, a Medical GroupGroup PAC ID 2769388412, 236 clinicians
Northwest Iowa Hospital CorporationGroup PAC ID 0749198026, 139 clinicians

Practice addresses (Care Compare)

27525 Puerta Real
Suite 300
Mission Viejo, CA 92691-6379
Phone (951) 312-5922

3650 E S St
Suite 310
Lakewood, CA 90712-1519
Phone (562) 531-1980

801 5TH St
Sioux City, IA 51101-1326
Phone (712) 279-2010

Hospital & facility affiliations

  • Uci Health-Lakewood Hospital, Lakewood, CA, CCN 050581
  • Uci Health-Orange Hospital, Orange, CA, CCN 050348
  • St Lukes Regional Medical Center Hospital, Sioux City, IA, CCN 160146
  • Deaconess Hospital Inc Hospital, Evansville, IN, CCN 150082

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101242737VAMDCardiovascular Disease Physician
A134183CAMDClinical Cardiac Electrophysiology Physician
MED-PHYS-LIC-129127MTMDClinical Cardiac Electrophysiology Physician
10038AWYMDClinical Cardiac Electrophysiology Physician

Practice roles (22 of 23)

OrganizationSpecialtyStatusNew patients
Prohealth Partners, a Medical Group Cardiovascular Disease Current Accepting new patients
Prohealth Partners a Medical Group Inc Family Medicine CurrentSince Nov 1, 2021 Accepting new patients
Prohealth Partners, a Medical Group, Inc. CurrentSince Nov 1, 2021 Accepting new patients
Health Services & Management Inc. Past Accepting new patients
Orange County Global Medical Center, Inc Past Accepting new patients
St Joseph Hospital of Orange Past Accepting new patients
Orange Coast Memorial Medical Center Past Accepting new patients
University of California Irvine Past Accepting new patients
Aurora Medical Center Grafton, LLC Past Accepting new patients
Prohealth Partners a Medical Group Inc Family Medicine Past Accepting new patients
Chapman Medical Center Inc Past Accepting new patients
Dakota Specialty Institute Past Accepting new patients
East Carolina Medical Associates P.C Past Accepting new patients
Alta Newport Hospital, LLC Past Accepting new patients
Providence Health System - Southern California Past Accepting new patients
Onslow Memorial Hospital Inc Past Accepting new patients
Providence Health & Services Mt Past Accepting new patients
Lewis-Gale Medical Center, LLC Past Accepting new patients
Memorial Hospital of Laramie County Past Accepting new patients
Anaheim Memorial Medical Center Past Accepting new patients
Anaheim Global Medical Center, Inc Past Accepting new patients
St Jude Hospital Inc Past Accepting new patients

Locations

3650 South St
Ste 403
Lakewood, CA 90712
Phone (562) 424-8422

3650 South St
Ste 210
Lakewood, CA 90712
Phone (562) 630-0910

3650 South St
Ste 310
Lakewood, CA 90712
Phone (310) 531-1980

File 54567
Los Angeles, CA 90074
Phone (310) 491-9060

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: jeubany299545@direct.myadvocateaurora.org
  • Direct secure messaging: jae113pcs@m1782.primeclinicalsystems.direct-ci.com
  • Direct secure messaging: jeubany446511@direct-ehr-ssmhc.com
  • FHIR API: https://api.platform.athenahealth.com/10459/brand/1/csg/1/fhir/r4

Organizations & group practices 24

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.

View all 24

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695686400000",
    "number": "1912986944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "438 E KATELLA AVE STE B",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928674857",
            "telephone_number": "714-744-5000",
            "fax_number": "714-744-5985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "438 E KATELLA AVE STE B",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928674857",
            "telephone_number": "714-744-5000",
            "fax_number": "714-744-5985"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 N Tustin Ave Ste 706",
            "address_purpose": "LOCATION",
            "city": "Santa Ana",
            "state": "CA",
            "postal_code": "927053611",
            "country_code": "US",
            "telephone_number": "714-568-6600",
            "fax_number": "714-245-0260",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1802 Braeburn Dr",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "VA",
            "postal_code": "241537357",
            "country_code": "US",
            "telephone_number": "540-772-3815",
            "fax_number": "540-776-2091",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "700 S Park St Ste A",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537151830",
            "country_code": "US",
            "telephone_number": "608-260-2900",
            "fax_number": "608-260-2956",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 W Broadway St",
            "address_purpose": "LOCATION",
            "city": "Missoula",
            "state": "MT",
            "postal_code": "598024008",
            "country_code": "US",
            "telephone_number": "406-329-5615",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EUBANY",
        "first_name": "JACQUELINE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-09",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "VA",
            "license": "0101242737",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "MT",
            "license": "MED-PHYS-LIC-129127",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "WY",
            "license": "10038A",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "CA",
            "license": "A134183",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "WI",
            "license": "81736-20",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "MN",
            "license": "70735",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912986944",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "975 Port Washington Rd",
            "city": "Grafton",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530249201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jeubany299545@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "975 Port Washington Rd",
            "city": "Grafton",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530249201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "700 S Park St Ste A",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537151830",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jeubany446511@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jeubany446511@direct-ehr-ssmhc.com",
            "address_1": "700 S Park St Ste A",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "537151830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.