NPIMap

Individual provider Active NPI

Jessica A Mathisen, PA-C

  • Medical Physician Assistant
  • Des Moines, IA
National Provider Identifier
1043365026
Registry record updated Sep 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
01747 Issued in IA
Practice address
1215 Pleasant Street
Suite 100
Des Moines, IA 50390-1409
Phone
(515) 241-5710
Fax
(515) 241-8004
NPI assigned
Jan 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 01747 IA Primary

Addresses

Primary practice location

1215 Pleasant Street
Suite 100
Des Moines, IA 50390-1409

Mailing address

1215 Pleasant Street
Suite 100
Des Moines, IA 50390-1409
Phone (515) 241-5710

Other identifiers 1

IdentifierTypeStateIssuer
01747OtherIAPHYSICIAN ASSISTANCE LICE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070219000820 IA Practitioner - Physician Assistant 5799887949 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iowa Kidney Physicians, P.C.Group PAC ID 7012806409, 15 clinicians

Practice addresses (Care Compare)

1215 Pleasant St
Des Moines, IA 50309-1409

1700 W Townline St
Creston, IA 50801-1054
Phone (641) 782-5202

5500 Westown Pkwy
West Des Moines, IA 50266-8202
Phone (515) 336-6557

Hospital & facility affiliations

  • Greater Regional Medical Center Hospital, Creston, IA, CCN 161365
  • Mercyone Des Moines Medical Center Hospital, Des Moines, IA, CCN 160083
  • Unitypoint Health - Des Moines Iowa Methodist Medi Hospital, Des Moines, IA, CCN 160082

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts, Physician Assistant

State licenses

LicenseStateTypeSpecialty
01747IAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Diagnostic & Critical Care Medicine Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jessicamathisen@ikppc.allscriptsdirect.net

Organizations & group practices 2

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

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315872000000",
    "number": "1043365026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 PLEASANT STREET",
            "address_2": "SUITE 100",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503901409",
            "telephone_number": "515-241-5710",
            "fax_number": "515-241-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 PLEASANT STREET",
            "address_2": "SUITE 100",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503901409",
            "telephone_number": "515-241-5710",
            "fax_number": "515-241-8004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHISEN",
        "first_name": "JESSICA",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2011-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IA",
            "license": "01747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANCE LICE",
            "identifier": "01747",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.