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JESSICA HETHCOAT
NPI 1558854018
Student in an Organized Health Care Education/Training Program in San Diego, CA

Active since June 10, 2018PECOS Enrolled
4077 FIFTH AVE # MER35, SAN DIEGO, CA 92103(619) 260-7220(619) 260-7305 Get Directions Write a Review

NPPES record last updated: October 25, 2024. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Jessica Hethcoat NPPES

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

JESSICA HETHCOAT (NPI 1558854018) is an individual student in an organized health care education/training program in San Diego, California and active in the NPI registry since June 2018. She is enrolled in Medicare PECOS and maintains a secondary practice location in Oakland.

NPPES Registry Identity

NPI1558854018
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameJESSICA HETHCOAT
Location Address4077 FIFTH AVE # MER35San Diego, CA 92103-2105
Mailing Address4077 Fifth Ave # Mer35San Diego, CA 92103-2105 · (619) 260-7220 · Fax (619) 260-7305
Phone(619) 260-7220
Fax(619) 260-7305
Sole ProprietorNo
Enumeration DateJune 10, 2018
Last NPPES UpdateOctober 25, 2024
✔ NPI 1558854018 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
4077 FIFTH AVE # MER35, San Diego, CA 92103
Open in Google Maps ↗

Secondary Practice Location 1

Location 1450 30th St Ste 2860Oakland, CA 94609-3302 · Phone (510) 879-9285

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jessica Hethcoat 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 Jessica Hethcoat reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Southern California Permanente Medical Group
1.3 mi
Health Maintenance Organization
1288 CAMINO DEL RIO N
San Diego, CA 92108
  • Reassigned Medicare billing, California enrollment
  • 13,921 clinicians in this Medicare group
NPI 1023425972 (877) 608-0044

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

Other Providers at the Same Location NPPES 20

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

DR. PRANAY RAG BONAGIRI DO
Internal Medicine
4077 FIFTH AVE # MER35
SAN DIEGO, CA 92103
San Diego County (619) 260-7220
ANDY M CHAN DO
Internal Medicine
4077 FIFTH AVE # MER35
SAN DIEGO, CA 92103
San Diego County (619) 294-8111
MARGARET CULVER MCDERMOTT MD
Internal Medicine
4077 FIFTH AVE # MER35
SAN DIEGO, CA 92103
San Diego County (619) 294-8111
KENNETH R STEVENS III
Internal Medicine
4077 FIFTH AVE # MER35
SAN DIEGO, CA 92103
San Diego County (503) 998-0614
CODY MITCHELL DELANEY
Internal Medicine
4077 FIFTH AVE # MER35
SAN DIEGO, CA 92103
San Diego County (619) 260-7220
JENNA LAVINA
Internal Medicine
4077 FIFTH AVE # MER35
SAN DIEGO, CA 92103
San Diego County (619) 260-7220
DR. CHRISTINA MANSOUR MD
Internal Medicine
4077 FIFTH AVE # MER35
SAN DIEGO, CA 92103
San Diego County (619) 260-7220
HAO PHUC NGUYEN D.O.
Student in an Organized Health Care Education/Training Program
4077 FIFTH AVE # MER35
SAN DIEGO, CA 92103
San Diego County (619) 260-7220

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 Jessica Hethcoat's NPI number?

The NPI number for Jessica Hethcoat is 1558854018. It was assigned to this individual provider in the NPPES registry on June 10, 2018.

Where is Jessica Hethcoat located?

Jessica Hethcoat practices at 4077 Fifth Ave # Mer35, San Diego, CA 92103. The listed phone number is (619) 260-7220.

What is Jessica Hethcoat's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Jessica Hethcoat enrolled in Medicare?

Yes. Jessica Hethcoat is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jessica Hethcoat's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jessica Hethcoat 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 Jessica Hethcoat'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 Jessica Hethcoat was last updated on October 25, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.