Individual provider Active NPI

Jansen Musselman, PAC

  • Physician Assistant
  • Uniontown, OH
National Provider Identifier
1134494461
Registry record updated Jul 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.003386 Issued in OH
Practice address
3730 Tabs Dr
Uniontown, OH 44685-9562
Phone
(330) 563-0603
NPI assigned
Mar 20, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2013

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 50.003386 OH Primary

Addresses

Primary practice location

3730 Tabs Dr
Uniontown, OH 44685-9562

Mailing address

272 Benedict Ave
Norwalk, OH 44857-2374
Phone (419) 668-7101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20130813000454 OH Practitioner - Physician Assistant 5193967685 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.003386OHMDPhysician Assistant

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.

NPI Registry JSON

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

{
    "created_epoch": "1332201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374624000000",
    "number": "1134494461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "272 BENEDICT AVE",
            "city": "NORWALK",
            "state": "OH",
            "postal_code": "448572374",
            "telephone_number": "419-668-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3730 TABS DR",
            "city": "UNIONTOWN",
            "state": "OH",
            "postal_code": "446859562",
            "telephone_number": "330-563-0603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUSSELMAN",
        "first_name": "JANSEN",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-20",
        "last_updated": "2013-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.003386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Uniontown, OH

Sources for this page

Verify at the official NPI Registry.