Jessica Sage Blank Mendonsa, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

AMD588 Issued in HI

Practice address

2120 Kaohu St
Wailuku, HI 96793-2205

Phone

(808) 377-4734

Fax

(808) 377-4734

NPI assigned

Nov 14, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Paradise Medical Services LLC

  • General Practice Physician
  • Wailuku, HI
  • NPI 1124666201
  NPD Authorized official

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

{
    "created_epoch": "1384387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643241600000",
    "number": "1124458930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2120 KAOHU ST",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932205",
            "telephone_number": "808-377-4734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 KAOHU ST",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932205",
            "telephone_number": "808-377-4734",
            "fax_number": "808-377-4734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDONSA",
        "first_name": "JESSICA",
        "middle_name": "SAGE BLANK",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-14",
        "last_updated": "2022-01-27",
        "certification_date": "2022-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "HI",
            "license": "AMD588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John G Meisel, MD
• Milba Rojas Melchor, CNA
• Angelo Melicano
• Kieran Melody, M.D.
• Alisa Mendez, RBT
• Mental Health Kokua
• Mental Health Kokua
• Mental Health Kokua
• Mental Health Kokua
• Mental Health Kokua

• Physician Assistant in Wailuku, HI
• Providers in Wailuku, HI by specialty
• Physician Assistant in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.