Jessica Dahlin, P.A.

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA22334 Issued in CA

Practice address

1700 Coffee Rd
Modesto, CA 95355-2803

Phone

(209) 526-4500

NPI assigned

Sep 7, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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

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 and National Provider Directory roles.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment NPD
• John P Kelly MD a Professional Medical Corporation

  • Orthopaedic Surgery Physician
  • Los Angeles, CA
  • NPI 1558586438
  Medicare reassignment
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD
• Golden State Orthopedics & Spine

  • Orthopaedic Surgery Physician
  • San Francisco, CA
  • NPI 1457004897
  NPD (past)

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

{
    "created_epoch": "1346976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640649600000",
    "number": "1083963805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 WEBSTER ST STE 500",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093149",
            "telephone_number": "510-465-6600",
            "fax_number": "510-839-0806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552803",
            "telephone_number": "209-526-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAHLIN",
        "first_name": "JESSICA",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-07",
        "last_updated": "2021-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA22334",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA22334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "710 Lawrence Expy",
            "city": "Santa Clara",
            "state": "CA",
            "country_code": "US",
            "postal_code": "950515173",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rosamani D'Souza, MD
• Sharon D'Souza, MD
• Terasa Lee Daffron
• Joseph Charles Dagostino, D.O.
• Sarah Dahl
• Kaelyn Dailey
• Charles Huston Daily, OD
• Daley Wellness Group, Psychological & Spiritual Health, P.C.
• Luzia C. Daley, PSY.D.
• Jolene Lynn Daly, LMFT

• Surgical Physician Assistant in Modesto, CA
• Providers in Modesto, CA by specialty
• Surgical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.