Active NPI
Alyssa Jenkins, PA-C
- Medical Physician Assistant
- Idaho Falls, ID
National Provider Identifier
1144772237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA-1436
- Practice address
- 3820 Crestwood LN
Idaho Falls, ID 83404 - Phone
- (208) 552-7700
- Fax
- (208) 552-1786
- NPI assigned
- Oct 25, 2016
- Last updated
- May 23, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA-1436 | ID | Primary |
Addresses
Primary practice location
3820 Crestwood LN
Idaho Falls, ID 83404
Mailing address
3820 Crestwood LN
Idaho Falls, ID 83404-4979
Phone (208) 552-7700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 4 Pillars of Success LLC | Current | Accepting new patients | |
| Just 4 Kids Health LLC | Past | Accepting new patients | |
| Just 4 Kids Health LLC | Past | Accepting new patients |
Locations
1675 Curlew Dr
Ammon, ID 83406
Phone (208) 523-5319
Organizations & group practices 5
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Rehabilitative Health Services
- Multi-Specialty Clinic/Center
- Ammon, ID
- NPI 1619134277
-
- Family Medicine Physician
- Idaho Falls, ID
- NPI 1033314273
-
dba Just 4 Kids Urgent Care
- Urgent Care Clinic/Center
- Idaho Falls, ID
- NPI 1043722259
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1477353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558569600000",
"number": "1144772237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3820 CRESTWOOD LN",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834044979",
"telephone_number": "208-552-7700",
"fax_number": "208-552-1786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3820 CRESTWOOD LN",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "83404",
"telephone_number": "208-552-7700",
"fax_number": "208-552-1786"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "ALYSSA",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-10-25",
"last_updated": "2019-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "ID",
"license": "PA-1436",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2019; 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.