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JACKIE IRENE NEMBO KOM APRN, AGPCNP-BC,
NPI 1285088369
Nurse Practitioner - Adult Health in San Diego, CA

Active since April 14, 2016PECOS EnrolledAccepts Medicare Assignment
17809 KACHINA CT, SAN DIEGO, CA 92127(619) 261-6328 Get Directions Write a Review

NPPES record last updated: October 12, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Jackie Irene Nembo Kom Aprn, Agpcnp-bc, NPPES

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

JACKIE IRENE NEMBO KOM APRN, AGPCNP-BC, (NPI 1285088369) is an individual adult health provider in San Diego, California, licensed in California (95002893) and active in the NPI registry since April 2016. She is enrolled in Medicare PECOS and is a graduate of Other (2015).

NPPES Registry Identity

NPI1285088369
Entity TypeIndividualFemale
Primary Taxonomy363LA2200X
Provider Legal NameJACKIE IRENE NEMBO KOMCredential: APRN, AGPCNP-BC,
Location Address17809 KACHINA CTSan Diego, CA 92127-1368
Mailing Address17809 Kachina CtSan Diego, CA 92127-1368 · (619) 261-6328
Phone(619) 261-6328
Sole ProprietorYes
Medical School CMSOtherGraduated 2015
Enumeration DateApril 14, 2016
Last NPPES UpdateOctober 12, 2021
NPPES CertifiedOctober 12, 2021
✔ NPI 1285088369 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2200X
License✔ Licensed in CA · 95002893
17809 KACHINA CT, San Diego, CA 92127
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jackie Irene Nembo Kom Aprn, Agpcnp-bc, is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4385932946
PECOS Enrollment IDI20161013001939
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 Jackie Nembo Kom reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Southern California Permanente Medical Group
17 mi
Health Maintenance Organization
4647 ZION AVE
San Diego, CA 92120
  • Reassigned Medicare billing, California enrollment
  • 13,921 clinicians in this Medicare group
NPI 1225060742 (619) 528-5000

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

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Telephone medical discussion with physician, 11-20 minutes 99442
This is a service where you have a phone conversation with your doctor for 11-20 minutes. It's used for discussing health concerns, reviewing test results, or managing ongoing conditions. It's a convenient way to receive medical advice without an in-person visit.
25 services13 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92127 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
$94.87 typical visit price
range $62.10 – $184.71
Typical copayment $23.71 (range $15.52 – $46.17)
Most-billed visit code 99203
Established Patient
$108.42 typical visit price
range $20.62 – $151.42
Typical copayment $27.10 (range $5.15 – $37.85)
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 Jackie Nembo Kom's NPI number?

The NPI number for Jackie Nembo Kom is 1285088369. It was assigned to this individual provider in the NPPES registry on April 14, 2016.

Where is Jackie Nembo Kom located?

Jackie Nembo Kom practices at 17809 Kachina Ct, San Diego, CA 92127. The listed phone number is (619) 261-6328.

What is Jackie Nembo Kom's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

Is Jackie Nembo Kom enrolled in Medicare?

Yes. Jackie Nembo Kom is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Jackie Nembo Kom's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jackie Nembo Kom reassigns Medicare benefits to Southern California Permanente Medical Group (San Diego, 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 Jackie Nembo Kom'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 Jackie Nembo Kom was last updated on October 12, 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.