IFEANYI JIMMY
NPI 1679189724
Marriage & Family Therapist in Manteca, CA
About Ifeanyi Jimmy NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
IFEANYI JIMMY (NPI 1679189724) is an individual marriage & family therapist in Manteca, California, licensed in California (132326) and active in the NPI registry since September 2020. He is enrolled in Medicare PECOS and is a graduate of Other (2021).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Ifeanyi Jimmy is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Ifeanyi Jimmy reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Stockton, CA 95205
- Reassigned Medicare billing, California enrollment
- Medicare enrollment name: County Of San Joaquin
- 195 clinicians in this Medicare group
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.
MANTECA, CA 95337
MANTECA, CA 95337
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 Ifeanyi Jimmy's NPI number?
The NPI number for Ifeanyi Jimmy is 1679189724. It was assigned to this individual provider in the NPPES registry on September 23, 2020.
Where is Ifeanyi Jimmy located?
Ifeanyi Jimmy practices at 302 Cherry Ln, Manteca, CA 95337. The listed phone number is (530) 893-0758.
What is Ifeanyi Jimmy's specialty?
The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.
Is Ifeanyi Jimmy enrolled in Medicare?
Yes. Ifeanyi Jimmy is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Ifeanyi Jimmy's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Ifeanyi Jimmy reassigns Medicare benefits to San Joaquin County Public Health Services (Stockton, 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 Ifeanyi Jimmy'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 Ifeanyi Jimmy was last updated on June 16, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.
# Ifeanyi Jimmy · NPI 1679189724
Marriage & Family Therapist provider in Manteca, California. Individual provider, active in the CMS NPPES registry since September 23, 2020.
## Identity
- **NPI:** 1679189724 (Entity type: Individual)
- **Enumerated:** September 23, 2020
- **Primary specialty:** Marriage & Family Therapist · taxonomy 106H00000X
- **State license:** 132326 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 302 CHERRY LN, Manteca, CA 95337-4311
- **Phone:** (530) 893-0758
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** San Joaquin County Public Health Services (NPI 1356453831, Stockton, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2021
## Record status
- **NPPES last updated:** June 16, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1679189724) · Data from the CMS NPPES public registry.