Jessica Lynn Runquist, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA6233 Issued in MA

Practice address

1675 Gar Hwy
Swansea, MA 02777-3901

Phone

(508) 490-5959

Fax

(508) 490-5960

NPI assigned

Jun 9, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Jessica Lynn Fall Former name

Medicare fee-for-service enrollment

Enrolled in MA, RI2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Group practices

Modern Dermatology of Massachusetts, PLLCGroup PAC ID 9133564115, 2 clinicians

Practice addresses (Care Compare)

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.

• Modern Dermatology of Massachusetts, PLLC

  • Dermatology Physician
  • Fall River, MA
  • NPI 1831964915
  Medicare reassignment Care Compare group
• Southcoast Physicians Group, Inc.

  • Family Medicine Physician
  • Fairhaven, MA
  • NPI 1336137629
  Medicare reassignment NPD
• Skinpros LLC

  • Dermatology Physician
  • Providence, RI
  • NPI 1881966901
  Medicare reassignment
• Southcoast Physicians Group, Inc.

  • Orthopaedic Surgery Physician
  • North Dartmouth, MA
  • NPI 1902201536
  NPD

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

{
    "created_epoch": "1496966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576195200000",
    "number": "1124557376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 GAR HWY",
            "city": "SWANSEA",
            "state": "MA",
            "postal_code": "027773901",
            "telephone_number": "508-490-5959",
            "fax_number": "508-490-5960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 GAR HWY",
            "city": "SWANSEA",
            "state": "MA",
            "postal_code": "027773901",
            "telephone_number": "508-490-5959",
            "fax_number": "508-490-5960"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1287 N Main St",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029041856",
            "country_code": "US",
            "telephone_number": "401-272-2724",
            "fax_number": "401-272-2784",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUNQUIST",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-09",
        "last_updated": "2019-12-13",
        "certification_date": "2019-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA6233",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA01115",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "FALL",
            "middle_name": "LYNN",
            "prefix": "MS.",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stuart Martin Rosenthal, D.C.
• Olivia Roskowski, PT
• Brittany Ross, DPT
• Michelle Rovoredo
• Danielle Shea Ruggieri, MD
• Robert Russ, PT MS DPT
• Nicole Saikali
• Ben Salvatore
• Sam Andrew Salvo, PT
• Julie Charisse Sanders, LICSW

• Physician Assistant in Swansea, MA
• Providers in Swansea, MA by specialty
• Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.