Jennifer B. Sissom, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

004267 Issued in GA

Practice address

2383 Pate St N
Snellville, GA 30078-3250

Phone

(770) 972-4845

NPI assigned

Feb 23, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Emory University School of Medicine, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gwinnett Dermatology, PC D/B/a Georgia Dermatology PartnersGroup PAC ID 6002804309, 19 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jennifer.sissom@pd.eclinicaldirectplus.com

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.

• Gwinnett Dermatology PC D/B/a Georgia Dermatology Partners

  • Dermatology Physician
  • Snellville, GA
  • NPI 1477596203
  Medicare reassignment Care Compare group
• Resurgens, LLC

  • Orthopaedic Surgery Physician
  • Atlanta, GA
  • NPI 1386697928
  NPD (past)

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

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1063488708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 MAPMAKER DR",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300197818",
            "telephone_number": "404-788-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2383 PATE ST N",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300783250",
            "telephone_number": "770-972-4845"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "758 Old Norcross Rd",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "300453385",
            "country_code": "US",
            "telephone_number": "770-962-4300",
            "fax_number": "770-339-7544",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SISSOM",
        "first_name": "JENNIFER",
        "middle_name": "B.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-23",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "004267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "824570839A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eric Loren Simrod, MD
• James Sims, D.D.S.
• Milss Sims, PCT/CNA
• Rashmi Sinha, MD
• Amsel Melka Siore, MD
• Sista'S Compassionate Care Services LLC
• Arvind Sivakumaran, M.D.
• Alex Skeeling, CSA
• Mary Lou Skelton, D.C.
• Rebecca Skelton

• Physician Assistant in Snellville, GA
• Providers in Snellville, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.