Jennifer Widjaja

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

317968 Issued in AZ

Practice address

8035 E Brown Rd
Mesa, AZ 85207-3901

Phone

(623) 295-1190

NPI assigned

Mar 6, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Leading Healthcare PLLCGroup PAC ID 1850652496, 42 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Banner Desert Medical Center Hospital, Mesa, AZ, CCN 030065

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Leading Healthcare, LLC

  • Hospitalist Physician
  • Sun City, AZ
  • NPI 1356853691
  Medicare reassignment Care Compare group NPD
• Leading Healthcare Clinic of Goodyear LLC

  • Internal Medicine Physician
  • Goodyear, AZ
  • NPI 1902448566
  Medicare reassignment NPD

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

• Banner Desert Medical Center

  • General Acute Care Hospital
  • Mesa, AZ
  • NPI 1720011810
  Care Compare affiliation

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

{
    "created_epoch": "1741219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741219200000",
    "number": "1942008651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9458 E THEIA DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852128545",
            "telephone_number": "480-240-0555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8035 E BROWN RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852073901",
            "telephone_number": "623-295-1190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDJAJA",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-06",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "AZ",
            "license": "317968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wholesome Therapy Solutions
• Bonnie Lynn Wick, N.D.
• Jonathan Wickes, PHARMD
• Linda C. Wicoff, RDH
• Morgan Widger
• Amanda Widmar, RDN
• Lawrence Wieland, LISAC
• Kristan Kay Wiemann, RN
• Belinda Wiens, M.C., LPC
• Harry Jake Wiens, MD

• Gerontology Nurse Practitioner in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Gerontology Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.