Prachi Jamadagni, BS, MS
Individual provider Active NPI Physician Assistant · Rexford, NY
NPI 1063294304 · NPPES record last updated Oct 20, 2023
Key facts
- NPI
- 1063294304
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 71 Blue Jay Way
Rexford, NY 12148 - Phone
- (518) 930-1987
- NPI assigned
- Oct 20, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240319004188 | NJ | Practitioner - Physician Assistant | 1456798941 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Bachelor of Science, Master of Science, Physician Assistant
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
71 Blue Jay Way
Rexford, NY 12148
Mailing address
71 Blue Jay Way
Rexford, NY 12148
Phone (518) 930-1987
Other providers in Rexford, NY
- Alexandra Elizabeth Halkovitch
- Rachel Ann Hazlett
- Lauren Marie Herbs
- Brian Herschenhorn
- Nichol Honsaker
- John Jaski
- Meghan Lee
- Fiona Mary Malmendier
- Lisa Andrea McCarthy
- John F Milburn
All providers in Rexford, NY · Physician Assistant in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.