Jennifer Jane Blevins, PA-C
Individual provider Active NPI Physician Assistant · N Las Vegas, NV
NPI 1124357066 · NPPES record last updated Oct 2, 2023
Key facts
- NPI
- 1124357066
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA2489 (NV)
- Practice address
- 1302 W Craig Rd Ste a
N Las Vegas, NV 89032-0247 - Phone
- (702) 473-8380
- Fax
- (702) 473-8383
- NPI assigned
- Dec 23, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- University of California, Davis School of Medicine, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Intermountain Medical Holdings Nevada Inc
Practice addresses (Care Compare)
1302 W Craig Rd
Suite a
N Las Vegas, NV 89032-0247
Phone (702) 473-8380
1302 W Craig Rd
Suite B
N Las Vegas, NV 89032-0248
Phone (702) 657-9555
4880 Wynn Rd
Las Vegas, NV 89103-5406
Phone (702) 871-5005
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, NV
- 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 |
|---|---|---|---|---|
| I20130531000431 | CA | Practitioner - Physician Assistant | 9739327842 | Reassigns benefits to 1 organization |
| I20220315001229 | NV | Practitioner - Physician Assistant | 9739327842 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA2489 | NV | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Scripps Health | Current | Accepting new patients | |
| Intermountain Medical Holdings Nevada Inc | Current |
Accepting new patients | |
| American River Internal Medicine Associates Inc | Past | Accepting new patients | |
| Monice Kwok, M.D., Inc. | Past | Accepting new patients | |
| Healthcare Partners Medical Group (Coats) LTD. | Past | Accepting new patients |
Locations
4880 Wynn Rd
Las Vegas, NV 89103
Phone (702) 382-4554
6355 S Buffalo Dr
Fl 3
Las Vegas, NV 89113
Phone (702) 479-4881
1302 W Craig Rd
Ste A
North Las Vegas, NV 89032
Phone (702) 473-8380
1397 S Loop Rd
Pahrump, NV 89048
Phone (775) 727-5500
Interoperability endpoints
- jblevins80123@scrippshlth.medalliesdirect.net
- jenniferblevins@hcpnv.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA20701 | CA | |
| Physician Assistant | 363A00000X | PA2489 | NV | Yes |
Addresses
Primary practice location
1302 W Craig Rd Ste a
N Las Vegas, NV 89032-0247
Mailing address
6355 S Buffalo Dr FL 3
Las Vegas, NV 89113-2133
Phone (702) 216-3346
Other practice location 1
6040 N. Martin Luther King Blvd
Ste 101
North Las Vegas, NV 89032
Phone (702) 380-1712
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124357066 | Medicaid | NV | |
| PA2489 | Other | NV | STATE LICENSE |
Other providers in N Las Vegas, NV
- Josephine Ann Blackburn
- Ashley Blackmore
- Shanel Blackson
- Ashley Blake
- Martha Blanco
- January Blue
- Kaylah Iman Blue
- Camille Jaime' Bohannan
- Anisa Lashawn Bolling
- Felicia Boney
All providers in N Las Vegas, NV · Physician Assistant in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 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.