Jae Lyn Burke, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

001251 Issued in NY

Practice address

66 Park Street
Elizabethtown, NY 12932

Phone

(518) 873-6896

NPI assigned

Oct 23, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• FHIR API: https://fhir-usa.unify.chbase.com/org/elizabe-e663f886

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.

• Elizabethtown Community Hospital

  • General Practice Physician
  • Elizabethtown, NY
  • NPI 1053656744
  NPD (past)
• Elizabethtown Community Hospital

  • Critical Access Hospital
  • Elizabethtown, NY
  • NPI 1891785184
  NPD (past)

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387497600000",
    "number": "1194808998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 PARK STREET",
            "address_2": "PO BOX 277",
            "city": "ELIZABETHTOWN",
            "state": "NY",
            "postal_code": "12932",
            "telephone_number": "518-873-6896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 PARK STREET",
            "city": "ELIZABETHTOWN",
            "state": "NY",
            "postal_code": "12932",
            "telephone_number": "518-873-6896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKE",
        "first_name": "JAE LYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-23",
        "last_updated": "2013-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "001251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "141364513",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason Todd Bradley, RPH
• Jeanne Brown, LPC, CSAC
• Nicole P Bryant, LMSW
• Mary Buehler-Brandt, RPA
• Korin Susan Burdo, RN
• Holly Ruth Burkey, NCC, LMHC-P
• Samantha Carlson
• Lucianna Celotti, B.S.
• Tammy Celotti
• Charles E Moisan Jr MD PC

• Medical Physician Assistant in Elizabethtown, NY
• Providers in Elizabethtown, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.