NPIMap

Individual provider Active NPI

Krystal Alicia Jimenez, M.D., M.S.

  • Family Medicine Physician
  • Chula Vista, CA
National Provider Identifier
1922531250
Registry record updated Jul 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A159831 Issued in CA
Practice address
678 3Rd Ave
Chula Vista, CA 91910-5736
Phone
(619) 662-4100
NPI assigned
Apr 4, 2017
Last updated
Jul 8, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2020

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 A159831 CA Primary

Addresses

Primary practice location

678 3Rd Ave
Chula Vista, CA 91910-5736

Mailing address

480 Fourth Ave Ste 403
Chula Vista, CA 91910-4413
Phone (619) 691-7479

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210108001052 CA Practitioner - Family Practice 2365855418 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
On Call Specialists Medical Group of San Diego IncGroup PAC ID 7911395231, 145 clinicians

Practice addresses (Care Compare)

4077 5TH Ave
San Diego, CA 92103-2105
Phone (619) 359-6600

678 3Rd Ave
Chula Vista, CA 91910-5736
Phone (619) 662-4100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A159831CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Current Accepting new patients
Centro de Salud de la Comunidad de San Ysidro Inc CurrentSince Sep 29, 2020 Accepting new patients
Scripps Mercy Physicians Cardiology Medical Corporation CurrentSince Dec 30, 2020 Accepting new patients
Scripps Health Current Accepting new patients
Centro de Salud de la Comunidad de San Ysidro Inc CurrentSince Sep 29, 2020 Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health Inpatient Providers Medical Group Inc. CurrentSince Apr 1, 2024 Accepting new patients
On Call Specialists Medical Group of San Diego, Inc. CurrentSince Aug 1, 2024 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Past Accepting new patients
Scripps Health Family Medicine Past Accepting new patients

Locations

1637 Third Ave
Ste B
Chula Vista, CA 91911
Phone (619) 425-1780

435 H St
Chula Vista, CA 91910
Phone (619) 691-7000

480 Fourth Ave
Ste 403
Chula Vista, CA 91910
Phone (619) 691-7587

678 Third Ave
Chula Vista, CA 91910

1136 D Ave
National City, CA 91950
Phone (619) 336-2300

4077 5th Ave
San Diego, CA 92103
Phone (619) 260-7245

1601 Precision Park Ln
San Ysidro, CA 92173
Phone (619) 205-4585

650 E Devon Ave
Ste 165
Itasca, IL 60143
Phone (630) 285-1040

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: kjimenez18984@syhealth.direct-ci.com
  • Direct secure messaging: kjimenez41800@scrippshlth.medalliesdirect.net

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1491264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594166400000",
    "number": "1922531250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 FOURTH AVE STE 403",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919104413",
            "telephone_number": "619-691-7479",
            "fax_number": "619-691-7120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "678 3RD AVE",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919105736",
            "telephone_number": "619-662-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ",
        "first_name": "KRYSTAL",
        "middle_name": "ALICIA",
        "name_prefix": "Dr.",
        "credential": "M.D., M.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-04",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A159831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.