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JESSIE WACKERMAN
NPI 1053085076
Nurse Practitioner - Acute Care in Corona, CA

Active since August 03, 2021PECOS Enrolled
4101 MOUNT CANTARA CIR, CORONA, CA 92882(714) 267-9817 Get Directions Write a Review

NPPES record last updated: August 3, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Jessie Wackerman NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JESSIE WACKERMAN (NPI 1053085076) is an individual acute care provider in Corona, California, licensed in California (95017895) and active in the NPI registry since August 2021. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1053085076
Entity TypeIndividualFemale
Primary Taxonomy363LA2100X
Provider Legal NameJESSIE WACKERMAN
Location Address4101 MOUNT CANTARA CIRCorona, CA 92882-7942
Mailing Address4101 Mount Cantara CirCorona, CA 92882-7942 · (714) 267-9817
Phone(714) 267-9817
Sole ProprietorYes
Enumeration DateAugust 3, 2021
NPPES CertifiedAugust 3, 2021
✔ NPI 1053085076 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2100X
License✔ Licensed in CA · 95017895
Also ListedNurse Practitioner · Adult HealthTaxonomy 363LA2200X · License 95017895 (CA)
Also ListedNurse Practitioner · GerontologyTaxonomy 363LG0600X · License 95017895 (CA)
4101 MOUNT CANTARA CIR, Corona, CA 92882
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jessie Wackerman is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Jessie Wackerman reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Southern California Permanente Medical Group
10 mi
Health Maintenance Organization
441 N LAKEVIEW AVE
Anaheim, CA 92807
  • Reassigned Medicare billing, California enrollment
  • 13,921 clinicians in this Medicare group
NPI 1952333460 (714) 279-4000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92882 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$91.88 typical visit price
range $59.60 – $179.42
Typical copayment $22.97 (range $14.90 – $44.85)
Most-billed visit code 99203
Established Patient
$104.64 typical visit price
range $19.37 – $146.42
Typical copayment $26.16 (range $4.84 – $36.60)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jessie Wackerman's NPI number?

The NPI number for Jessie Wackerman is 1053085076. It was assigned to this individual provider in the NPPES registry on August 3, 2021.

Where is Jessie Wackerman located?

Jessie Wackerman practices at 4101 Mount Cantara Cir, Corona, CA 92882. The listed phone number is (714) 267-9817.

What is Jessie Wackerman's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.

Is Jessie Wackerman enrolled in Medicare?

Yes. Jessie Wackerman is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jessie Wackerman's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jessie Wackerman reassigns Medicare benefits to Southern California Permanente Medical Group (Anaheim, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jessie Wackerman's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jessie Wackerman was last updated on August 3, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.