Jade Lynn Holley, PAC
Individual provider Active NPI Medical Physician Assistant · Moosic, PA
NPI 1134421183 · NPPES record last updated Jan 3, 2017
Key facts
- NPI
- 1134421183
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- MA054639 (PA)
- Practice address
- 532 Main St
Suite 1
Moosic, PA 18507-1001 - Phone
- (570) 471-3569
- NPI assigned
- Nov 24, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Geisinger Clinic
Practice addresses (Care Compare)
100 N Academy Ave
Danville, PA 17822-9800
Phone (570) 271-6144
532 Main St
Suite 1
Moosic, PA 18507-1001
Phone (570) 471-3569
Hospital & facility affiliations
- Regional Hospital of Scranton
- Allied Services Institute of Rehabilitation
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150521000868 | PA | Practitioner - Physician Assistant | 6507085065 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA054639 | PA | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Geisinger Clinic | Current |
Accepting new patients | |
| Geisinger Clinic | Current |
Accepting new patients | |
| Geisinger Clinic | Past | Accepting new patients |
Locations
100 N Academy Ave
Danville, PA 17822
532 Main St
Ste 1
Moosic, PA 18507
Phone (570) 471-3569
1140 Quincy Ave
Scranton, PA 18510
Phone (570) 347-4420
Interoperability endpoints
- jholley@primemed.medentdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | MA054639 | PA | Yes |
Addresses
Primary practice location
532 Main St
Suite 1
Moosic, PA 18507-1001
Mailing address
532 Main St
Suite 1
Moosic, PA 18507-1001
Phone (570) 471-3569
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103213688-0001 | Medicaid | PA |
Other providers in Moosic, PA
- Edward Ryan Hayes
- Laurie Elizabeth Healey
- Healing Hearts Counseling LLC
- Jacob Herber
- James Steven Hoban I
- Laurann Teresa Hoover
- Hospice of the Sacred Heart
- Hospital Drive Homecare, Inc
- Alexis Marie Huff
- Ahna Nicole Hyrowich
All providers in Moosic, PA · Medical Physician Assistant in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.