Jessica Manzolillo, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA051051 Issued in PA

Practice address

175 S Wilkes Barre Blvd
Wilkes Barre, PA 18702-5040

Phone

(570) 208-6281

Fax

(570) 208-6282

NPI assigned

Nov 14, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jmanzolillo152743@direct.geisinger.edu

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.

• Caring Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Wilkes Barre, PA
  • NPI 1679038293
  Medicare reassignment NPD (past)
• Geisinger Clinic

  • Family Medicine Physician
  • Danville, PA
  • NPI 1366493868
  Medicare reassignment
• Geisinger-HM Joint Venture, LLC

  dba Geisinger Medical Clinic Lock Haven

  • Family Medicine Physician
  • Lock Haven, PA
  • NPI 1144876137
  Medicare reassignment
• Caring Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Scranton, PA
  • NPI 1891547964
  NPD
• Geisinger Clinic

  • Family Medicine Physician
  • Kingston, PA
  • NPI 1356816904
  NPD
• Geisinger Clinic

  • Diagnostic Radiology Physician
  • Danville, PA
  • NPI 1558313023
  NPD
• Geisinger-HM Joint Venture, LLC

  • Family Medicine Physician
  • Williamsport, PA
  • NPI 1073075909

  Physician Assistant

  NPD
• Geisinger-HM Joint Venture, LLC

  • Gastroenterology Physician
  • Montoursville, PA
  • NPI 1396207015
  NPD
• Geisinger Clinic

  • Hospitalist Physician
  • Wilkes Barre, PA
  • NPI 1588614358
  NPD (past)

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

{
    "created_epoch": "1131926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596153600000",
    "number": "1174504468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144",
            "fax_number": "570-271-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 S WILKES BARRE BLVD",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187025040",
            "telephone_number": "570-208-6281",
            "fax_number": "570-208-6282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANZOLILLO",
        "first_name": "JESSICA",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-14",
        "last_updated": "2020-07-31",
        "certification_date": "2020-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA051051",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA051051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmanzolillo152743@direct.geisinger.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "175 S Wilkes Barre Blvd",
            "city": "Wilkes Barre",
            "state": "PA",
            "country_code": "US",
            "postal_code": "187025040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristen Marie Mannix, RD, LDN
• Tarannum Mansuri, PHARM. D
• Victoria Victor Manyele
• Shahid A Manzar, MD
• Jeffrey Michael Manzo, DMD
• Robert J Marbach, PAC
• Johnathan Christopher Marchena
• David P Marchetti Jr., ATC, CSCS
• Megan Margavage, RN
• Robin Michelle Marichak, ATHLETIC TRAINER

• Physician Assistant in Wilkes Barre, PA
• Providers in Wilkes Barre, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2020; 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.