Individual provider Active NPI

Elissa Jordan Coleman, PA-C

  • Physician Assistant
  • Brockton, MA
National Provider Identifier
1124783485
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
680 Centre St
Brockton, MA 02302-3308
Phone
(508) 941-7000
NPI assigned
Nov 2, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA8434 MA
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

680 Centre St
Brockton, MA 02302-3308

Mailing address

680 Centre St
Brockton, MA 02302-3308

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20220114001976 MA Practitioner - Physician Assistant 4587056999 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Signature Healthcare Medical Group IncGroup PAC ID 7719876267, 250 clinicians

Practice addresses (Care Compare)

680 Centre St
Brockton, MA 02302-3308
Phone (508) 941-7000

Hospital & facility affiliations

  • Signature Healthcare Brockton Hospital Hospital, Brockton, MA, CCN 220052

Merit-based Incentive Payment System (MIPS)

Final score
88.83 of 100Reported as group
Quality
70.13
Promoting interoperability
100
Improvement activities
40
Cost
75.97

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA8434MAMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: elissa.coleman@direct.signature.masshiway.net

Organizations & group practices 1

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 1

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": "1635811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1124783485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 CENTRE ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023023308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 CENTRE ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023023308",
            "telephone_number": "508-941-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLEMAN",
        "first_name": "ELISSA",
        "middle_name": "JORDAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-02",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA8434",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.