Individual provider Active NPI

Jacqueline Julty, PA-C

  • Physician Assistant
  • Palo Alto, CA
National Provider Identifier
1184759649
Registry record updated Jul 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
8397 Issued in WI
Practice address
3801 Miranda Ave
Palo Alto, CA 94304-1207
Phone
(650) 498-5000
NPI assigned
Feb 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA 11877 CA
Physician Assistant 363A00000X 8397 WI Primary

Addresses

Primary practice location

3801 Miranda Ave
Palo Alto, CA 94304-1207

Mailing address

2500 Grant Rd
Mountain View, CA 94040-4302
Phone (650) 940-7000

Other practice location 1

1000 North Oak Avenue
Marshfield, WI 54449-5703
Phone (715) 387-5511

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address him@marshfieldclinichealthsystem.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, WI2 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

Enrollment IDStateProvider typePAC IDDetails
I20050224000702 CA Practitioner - Physician Assistant 6608829122 Reassigns benefits to 1 organization
I20250625002910 WI Practitioner - Physician Assistant 6608829122 Reassigns benefits to 6 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
8397WIMDClinical Social Worker
PA 11877CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital Inc CurrentSince Jun 23, 2025 Accepting new patients
Lakeview Medical Center Inc of Rice Lake CurrentSince Jun 23, 2025 Accepting new patients
Beaver Dam Community Hospitals Inc CurrentSince Jun 23, 2025 Accepting new patients
MCHS Hospitals Inc CurrentSince Jun 23, 2025 Accepting new patients
Flambeau Hospital Inc CurrentSince Jun 23, 2025 Accepting new patients
MCHS Hospitals Inc CurrentSince Jun 23, 2025 Accepting new patients
Marshfield Clinic Inc CurrentSince Jun 23, 2025 Accepting new patients
Flambeau Hospital Inc CurrentSince Jun 23, 2025 Accepting new patients
Lakeview Medical Center Inc of Rice Lake CurrentSince Jun 23, 2025 Accepting new patients

Locations

705 S University Ave
Beaver Dam, WI 53916
Phone (920) 885-6090

3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200

1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111

1102 S Center Ave
Merrill, WI 54452
Phone (715) 536-3399

N3708 River Ave
Neillsville, WI 54456
Phone (715) 743-3101

1700 W Stout St
Rice Lake, WI 54868
Phone (715) 236-6133

Organizations & group practices 11

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": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751414400000",
    "number": "1184759649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 GRANT RD",
            "city": "MOUNTAIN VIEW",
            "state": "CA",
            "postal_code": "940404302",
            "telephone_number": "650-940-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 MIRANDA AVE",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041207",
            "telephone_number": "650-498-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 North Oak Avenue",
            "address_purpose": "LOCATION",
            "city": "Marshfield",
            "state": "WI",
            "postal_code": "544495703",
            "country_code": "US",
            "telephone_number": "715-387-5511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JULTY",
        "first_name": "JACQUELINE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-23",
        "last_updated": "2025-07-02",
        "certification_date": "2025-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA 11877",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "8397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@marshfieldclinichealthsystem.cernerdirect.com",
            "affiliation": "N",
            "address_1": "1000 North Oak Avenue",
            "city": "Marshfield",
            "state": "WI",
            "country_code": "US",
            "postal_code": "544495703",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Palo Alto, CA

Sources for this page

Verify at the official NPI Registry.