Individual provider Active NPI

Jessica E Muccianti, PA C

  • Physician Assistant
  • Rockford, IL
National Provider Identifier
1104065598
Registry record updated Feb 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085 003424 Issued in IL
Practice address
1253 N Alpine Rd
Rockford, IL 61107
Phone
(779) 696-9201
NPI assigned
Feb 10, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085 003424 IL Primary

Addresses

Primary practice location

1253 N Alpine Rd
Rockford, IL 61107

Mailing address

PO Box 78866
Milwaukee, WI 53278-8866
Phone (779) 696-7150

Other names 1

  • Jessica E Meyers Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jmuccianti911691@direct.uwhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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

Enrollment IDStateProvider typePAC IDDetails
I20090324000314 IL Practitioner - Physician Assistant 3971660614 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Swedishamerican HospitalGroup PAC ID 5799698346, 386 clinicians

Practice addresses (Care Compare)

1253 N Alpine Rd
Sa Brookside Specialty Center
Rockford, IL 61107-2201
Phone (779) 696-9201

6824 Newburg Rd
Sa Valley
Rockford, IL 61108-4330
Phone (779) 696-7610

Hospital & facility affiliations

  • Uw Health Hospital, Rockford, IL, CCN 140228

Merit-based Incentive Payment System (MIPS)

Final score
81.51 of 100Reported as group
Quality
83.2
Promoting interoperability
77
Improvement activities
40
Cost
71.7

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085 003424ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Swedishamerican Hospital CurrentSince Jun 15, 2011 Accepting new patients
Swedishamerican Hospital Physician Assistant CurrentSince Jun 15, 2011 Accepting new patients
Swedishamerican Hospital Past Accepting new patients

Locations

1253 N Alpine Rd
Rockford, IL 61107
Phone (779) 696-9201

6824 Newburg Rd
Rockford, IL 61108
Phone (779) 696-7610

Interoperability endpoints

  • Direct secure messaging: dschiffer1281408@direct.uwhealth.org

Organizations & group practices 3

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 1

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": "1234224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613692800000",
    "number": "1104065598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 78866",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532788866",
            "telephone_number": "779-696-7150",
            "fax_number": "779-696-7342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1253 N ALPINE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61107",
            "telephone_number": "779-696-9201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUCCIANTI",
        "first_name": "JESSICA",
        "middle_name": "E",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-10",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085 003424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmuccianti911691@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "1253 N Alpine Rd",
            "city": "Rockford",
            "state": "IL",
            "country_code": "US",
            "postal_code": "61107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "MEYERS",
            "middle_name": "E",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.