Ashley L Jack, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

655 Seventh Street, BLDG 700
Centerville, GA 31028

Phone

(303) 931-8976

NPI assigned

Feb 29, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, MD2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Peachtree Immediate Care FP, LLC

  • Family Medicine Physician
  • Hiram, GA
  • NPI 1437194156

  GA

  Medicare reassignment
• Urgent Care Medicine, LLC

  • Urgent Care Clinic/Center
  • Edgewater, MD
  • NPI 1174804918

  MD

  Medicare reassignment

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

{
    "created_epoch": "1330473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431388800000",
    "number": "1134493620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 VALENCIA CIR",
            "city": "CENTERVILLE",
            "state": "GA",
            "postal_code": "310281339",
            "telephone_number": "303-931-8976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 SEVENTH STREET, BLDG 700",
            "city": "CENTERVILLE",
            "state": "GA",
            "postal_code": "31028",
            "telephone_number": "303-931-8976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACK",
        "first_name": "ASHLEY",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-02-29",
        "last_updated": "2015-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Envision Optics LLC
• Karen Ann Floyd, ORTHOTIC SHOE FITTER
• Joi Sabrina G Gay, LPC
• Latrisha Griffin
• Helping Hands Transport, LLC
• James Inman Kile, RPH
• Love & Care Home Health Care
• George Bernard Meyer Von Bremen, PHARM.D.
• Montford Medical Services
• Neuropsychological Testing and Counseling

• All providers in Centerville, GA
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.