Individual provider Active NPI

Jennifer Coy, PA-C

  • Surgical Physician Assistant
  • Newport Beach, CA
National Provider Identifier
1942356035
Registry record updated Dec 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA18467 Issued in CA
Practice address
1401 Avocado Ave
Suite 307
Newport Beach, CA 92660-7720
Phone
(949) 720-1944
NPI assigned
Jan 25, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA18467 CA
Medical Physician Assistant 363AM0700X PA18467 CA
Surgical Physician Assistant 363AS0400X PA18467 CA Primary

Addresses

Primary practice location

1401 Avocado Ave
Suite 307
Newport Beach, CA 92660-7720

Mailing address

1401 Avocado Ave
Suite 307
Newport Beach, CA 92660-7720
Phone (949) 720-1944

Other identifiers 1

IdentifierTypeStateIssuer
PA18467OtherCAPA-C LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20141217001361 CA Practitioner - Physician Assistant 8628391927 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA18467CAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group Inc CurrentSince Jan 17, 2023 Accepting new patients
Permanente Medical Group, Inc CurrentSince Jan 17, 2023 Accepting new patients

Locations

1800 Harrison St
Fl 7
Oakland, CA 94612

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

501 J St
Sacramento, CA 95814
Phone (916) 497-3000

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

5615 Scotts Valley Dr
Scotts Valley, CA 95066
Phone (831) 430-2700

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

Organizations & group practices 3

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": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544572800000",
    "number": "1942356035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 AVOCADO AVE",
            "address_2": "SUITE 307",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607720",
            "telephone_number": "949-720-1944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 AVOCADO AVE",
            "address_2": "SUITE 307",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607720",
            "telephone_number": "949-720-1944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COY",
        "first_name": "JENNIFER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2018-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA18467",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA18467",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA18467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA-C LICENSE",
            "identifier": "PA18467",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

Verify at the official NPI Registry.