Jennifer Scidmore, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

54369 Issued in CA

Practice address

3801 Spring St
Racine, WI 53405

Phone

(262) 687-4011

NPI assigned

Nov 30, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Saint Johns Medical FoundationGroup PAC ID 0840548624, 282 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint John's Health Center Hospital, Santa Monica, CA, CCN 050290

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Providence Saint Johns Medical Foundation

  dba Saint John's Physician Partners

  • Specialist
  • Santa Monica, CA
  • NPI 1770093734
  Medicare reassignment Care Compare group NPD
• Torrance Health Association Inc

  dba Torrance Memorial Physician Network

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1083903124
  Medicare reassignment NPD
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • Santa Ana, CA
  • NPI 1548667843
  Medicare reassignment
• Saint Johns Emergency Medicine Specialists Inc a Medical Group

  • Emergency Medicine Physician
  • Santa Monica, CA
  • NPI 1609888940
  Medicare reassignment
• Cep America-California

  • Emergency Medicine Physician
  • Lakewood, CA
  • NPI 1073298451
  NPD
• Cep America-California

  • Emergency Medicine Physician
  • Murrieta, CA
  • NPI 1588552848
  NPD
• Petrel Emergency Physicians, a Medical Corporation

  • Emergency Medicine Physician
  • Marina del Rey, CA
  • NPI 1154734663
  NPD (past)
• Providence Saint John's Health Center

  • General Acute Care Hospital
  • Santa Monica, CA
  • NPI 1124026273
  NPD (past)
• Saint John's Health Clinic

  dba Providence Saint John's Health Clinic

  • Specialist
  • Santa Monica, CA
  • NPI 1336438902
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Saint John's Health Center

  • General Acute Care Hospital
  • Santa Monica, CA
  • NPI 1124026273
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1448841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624665600000",
    "number": "1033583190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3760 N FREMONT ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606133927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 SPRING ST",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "53405",
            "telephone_number": "262-687-4011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCIDMORE",
        "first_name": "JENNIFER",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-30",
        "last_updated": "2021-06-26",
        "certification_date": "2021-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "3698-23",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "3698-23",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "54369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronald E. Schulgit, M.D.
• Tyler A Schultz
• Celia Mary Schulz, RN, C
• Jeffrey H Schulz, LPC, CSAC, ICS
• Amanda Schwartz
• Debra Scott, OT/L
• Natalie Scott, OT
• Kelly Denise Scroggins
• SE Wisconsin Chiropractic LLC
• Sandra Kay Seck, RN

• Physician Assistant in Racine, WI
• Providers in Racine, WI by specialty
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.