Jenna Lee Dubruiel, PA
Individual provider Active NPI Physician Assistant · Dyer, TN
NPI 1114281748 · NPPES record last updated Dec 11, 2023
Key facts
- NPI
- 1114281748
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 2166 (TN)
- Practice address
- 1123 N Main St
Dyer, TN 38330-1019 - Phone
- (731) 692-2853
- Fax
- (731) 692-2367
- NPI assigned
- Jun 28, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Presley Diabetes and Endocrine Center, PLLC
Southeastern Physician Services PC
Practice addresses (Care Compare)
108 E Dr
Newbern, TN 38059-1404
Phone (731) 285-6600
1201 Bishop St
Union City, TN 38261-5403
Phone (731) 885-2410
Hospital & facility affiliations
- Amedisys Home Health Care
- Baptist Memorial Hospital Union City
- Jackson-Madison County General Hospital
- Dyersburg Regional Medical Center
- Volunteer Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- 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 |
|---|---|---|---|---|
| I20120821001098 | TN | Practitioner - Physician Assistant | 5294982526 | Reassigns benefits to 7 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fast Pace Medical Clinic PLLC | Current |
Accepting new patients | |
| Fast Pace Medical Clinic PLLC | Current |
Accepting new patients | |
| Dyersburg Family Walk-in Clinic LLC | Current |
Accepting new patients | |
| Presley Diabetes and Endocrine Center, PLLC | Current |
Accepting new patients | |
| Memphis Radiological, PC | Past | Accepting new patients |
Locations
1954 Saint John Ave
Ste 1
Dyersburg, TN 38024
Phone (731) 285-6110
2017 Saint John Ave
Ste B
Dyersburg, TN 38024
Phone (731) 285-6110
108 East Dr
Newbern, TN 38059
Phone (731) 285-6600
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/BDAADD/Endpoint/BDAADD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2166 | TN | Yes |
Addresses
Primary practice location
1123 N Main St
Dyer, TN 38330-1019
Mailing address
1123 N Main St
Dyer, TN 38330-1019
Phone (731) 692-2853
Other providers in Dyer, TN
- Stephen Baird
- Lauren S Blackwood
- Paul Thomas Blair
- Gary James Buchanan
- Jamie Burrus
- Douglas R Duncan
- Dyer Nursing Home, Inc.
- Dyer Station Pharmacy, LLC
- Dyer Station Pharmacy, LLC
- Dyer Station Pharmacy, LLC
All providers in Dyer, TN · Physician Assistant in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 11, 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.