NPIMap

Individual provider Active NPI

Jessica Frances Tidd, PA

  • Physician Assistant
  • Truckee, CA
National Provider Identifier
1124699426
Registry record updated Nov 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA61757 Issued in CA
Practice address
10956 Donner Pass Rd Ste 110
Truckee, CA 96161-4860
Phone
(530) 581-8864
NPI assigned
Jul 7, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X PA61757 CA Primary

Addresses

Primary practice location

10956 Donner Pass Rd Ste 110
Truckee, CA 96161-4860

Mailing address

10956 Donner Pass Rd Ste 110
Truckee, CA 96161-4860
Phone (408) 497-0911

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221129000633 CA Practitioner - Physician Assistant 8022486877 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tahoe Forest Hospital DistrictGroup PAC ID 0446161335, 140 clinicians

Practice addresses (Care Compare)

10051 Lake Ave
Suite 3
Truckee, CA 96161-4870
Phone (530) 587-7461

10956 Donner Pass Rd
Truckee, CA 96161-4860

Hospital & facility affiliations

  • Tahoe Forest Hospital Hospital, Truckee, CA, CCN 051328
  • Incline Village Community Hospital Hospital, Incline Village, NV, CCN 291301

Merit-based Incentive Payment System (MIPS)

Final score
75.06 of 100Reported as group
Quality
83.97
Promoting interoperability
88
Improvement activities
40
Cost
42.89

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
61757CAMDClinical Social Worker
PA61757CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tahoe Forest Hospital District Single Specialty CurrentSince Oct 4, 2022 Accepting new patients
Tahoe Forest Hospital District CurrentSince Oct 4, 2022 Accepting new patients

Locations

10051 Lake Ave
Ste 3
Truckee, CA 96161
Phone (530) 587-7461

10956 Donner Pass Rd
Ste 110
Truckee, CA 96161
Phone (530) 581-8864

10956 Donner Pass Rd
Ste 230
Truckee, CA 96161
Phone (530) 582-3277

880 Alder Ave
Fl 2
Incline Vlg, NV 89451
Phone (775) 831-5308

880 Alder Ave
Fl Second
Incline Vlg, NV 89451
Phone (775) 831-5308

Organizations & group practices 12

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1625616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669766400000",
    "number": "1124699426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10956 DONNER PASS RD STE 110",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961614860",
            "telephone_number": "408-497-0911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10956 DONNER PASS RD STE 110",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961614860",
            "telephone_number": "530-581-8864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDD",
        "first_name": "JESSICA",
        "middle_name": "FRANCES",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-07",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA61757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Truckee, CA

Sources for this page

Verify at the official NPI Registry.