MRS. JENNIFER ANNE JOHNSTAD PA-C
NPI 1336325620
Physician Assistant - Medical in San Diego, CA

Q: What is Jennifer Johnstad's NPI number?

The NPI number for Jennifer Johnstad is 1336325620. It was assigned to this individual provider in the NPPES registry on January 16, 2008. The provider is also known as Jennifer Anne Roberts Pa-C.

Q: What is Jennifer Johnstad's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: When was this NPI record last updated?

The NPPES record for Jennifer Johnstad was last updated on May 6, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.

Active since January 16, 2008PECOS EnrolledAccepts Medicare Assignment

5717 PACIFIC CENTER BLVD STE 200, SAN DIEGO, CA 92121(858) 859-1188 Get Directions Write a Review

NPPES record last updated: May 6, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 6, 2019, Jan 28, 2019 (2 updates tracked since 2019).

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About Mrs. Jennifer Anne Johnstad Pa-c NPPES

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

MRS. JENNIFER ANNE JOHNSTAD PA-C (NPI 1336325620) is an individual medical provider in San Diego, California, licensed in California (PA55545) and active in the NPI registry since January 2008. She is enrolled in Medicare PECOS, maintains a secondary practice location in Mesa, and is a graduate of Other (1997).

NPPES Registry Identity

NPI1336325620

Entity TypeIndividualFemale

Primary Taxonomy363AM0700X

Provider Legal NameMRS. JENNIFER ANNE JOHNSTADCredential: PA-C

Location Address5717 PACIFIC CENTER BLVD STE 200San Diego, CA 92121-4250

Mailing Address5717 Pacific Center Blvd Ste 200San Diego, CA 92121-4250 · (858) 859-1188 · Fax (480) 512-5486

Phone(858) 859-1188

Sole ProprietorNo

Medical School CMSOtherGraduated 1997

Enumeration DateJanuary 16, 2008

Last NPPES UpdateMay 6, 20192 updates tracked since enumeration

✔ NPI 1336325620 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in CA · PA55545

Also ListedPhysician Assistant · SurgicalTaxonomy 363AS0400X · License 2492 (AZ)

5717 PACIFIC CENTER BLVD STE 200, San Diego, CA 92121

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Other Names 1

Former Name (1)Jennifer Anne Roberts Pa-c

Secondary Practice Location 1

Location 11500 S Dobson Rd, Suite 203Mesa, AZ 85202-4713 · Phone (480) 512-3970 · Fax (480) 512-5486

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mrs. Jennifer Anne Johnstad Pa-c 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 ID1658444302

PECOS Enrollment IDI20251226000497, I20260416003122

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.

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GINGER R LUCERO PA-C

Physician Assistant