Jesse Elizabeth Childs, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

7598 Issued in GA

Practice address

1300 South Drive
Winnebago, WI 54985-5498

Phone

(920) 235-4910

NPI assigned

Mar 30, 2016

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 names 1

• Jesse Elizabeth. Dibrell Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Savannah Diagnostic Assoc PC

  • Specialist
  • Savannah, GA
  • NPI 1548267438
  Medicare reassignment
• Southland Optim Jenkins Emergency Medical Services, LLC

  • Emergency Medicine Physician
  • Millen, GA
  • NPI 1265826242
  Medicare reassignment
• Costrini Sleep Services, Inc.

  • Pulmonary Disease Physician
  • Bluffton, SC
  • NPI 1578816716
  NPD
• Southland Optim Jenkins Emergency Medical Services, LLC

  • Emergency Medicine Physician
  • Hinesville, GA
  • NPI 1477913580
  NPD
• Winnebago Mental Health Institute

  • Psychiatric Hospital
  • Winnebago, WI
  • NPI 1164516506
  NPD (past)

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

{
    "created_epoch": "1459296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1104289099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12345 MERCY BLVD",
            "city": "SAAVANNAH",
            "state": "GA",
            "postal_code": "31419",
            "telephone_number": "912-927-3046",
            "fax_number": "912-925-0597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 SOUTH DRIVE",
            "city": "WINNEBAGO",
            "state": "WI",
            "postal_code": "549855498",
            "telephone_number": "920-235-4910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHILDS",
        "first_name": "JESSE",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-30",
        "last_updated": "2023-07-05",
        "certification_date": "2023-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "7598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSE",
            "last_name": "DIBRELL",
            "middle_name": "ELIZABETH.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Paul J Barfknecht, RPH
• Kent M Berney, PHD
• Michelle Kaye Burton, APNP
• Charlene A Cain
• Christine N Carriere, APNP
• Cognitive Continuum Care
• Ann Patrice Decker, OTR
• Raul M Dejesus, M.D.
• Alejandro A Eisma, MD
• Louis M Fulton, MD

• Medical Physician Assistant in Winnebago, WI
• Providers in Winnebago, WI by specialty
• Medical Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; 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.