Individual provider Active NPI

Jessica McWatters, PAC

  • Physician Assistant
  • Fremont, MI
National Provider Identifier
1124889852
Registry record updated Apr 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601012120 Issued in MI
Practice address
230 W Oak St
Fremont, MI 49412-1526
Phone
(231) 924-4200
NPI assigned
Jan 19, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601012120 MI Primary

Addresses

Primary practice location

230 W Oak St
Fremont, MI 49412-1526

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20240315000822 MI Practitioner - Physician Assistant 4981040680 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Newaygo County General Hospital AssociationGroup PAC ID 4880503051, 64 clinicians

Practice addresses (Care Compare)

230 W Oak St
Corewell Health Gerber Hospital
Fremont, MI 49412-1526
Phone (231) 924-4200

Hospital & facility affiliations

  • Corewell Health Gerber Hospital Hospital, Fremont, MI, CCN 231338

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Newaygo County General Hospital Association CurrentSince Apr 1, 2024 Accepting new patients
Newaygo County General Hospital Association CurrentSince Apr 1, 2024 Accepting new patients

Locations

212 S Sullivan Ave
Fremont, MI 49412
Phone (231) 924-1212

230 W Oak St
Fremont, MI 49412
Phone (231) 924-1305

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

Interoperability endpoints

  • Direct secure messaging: jmcwatters2010532@epic00.corewelldirect.org

Organizations & group practices 2

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": "1705622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712534400000",
    "number": "1124889852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 W OAK ST",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "494121526",
            "telephone_number": "231-924-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCWATTERS",
        "first_name": "JESSICA",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-19",
        "last_updated": "2024-04-08",
        "certification_date": "2024-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601012120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, MI

Sources for this page

Verify at the official NPI Registry.