Individual provider Active NPI

Jessica Eleanor Newman, PA-C

  • Physician Assistant
  • Mocksville, NC
National Provider Identifier
1205135258
Registry record updated Mar 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001002821 Issued in NC
Practice address
485 Valley Rd
Mocksville, NC 27028-2074
Phone
(336) 751-8000
Fax
(336) 751-8010
NPI assigned
Mar 16, 2011
Last updated
Mar 14, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2023

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 001002821 NC Primary

Addresses

Primary practice location

485 Valley Rd
Mocksville, NC 27028-2074

Mailing address

PO Box 751803
Charlotte, NC 28275-1803

Other practice location 1

1617 N Main St Ste 100
Fuquay Varina, NC 27526-9021
Phone (919) 577-9952

Other practice location 2

2604 Medical Office Pl
Goldsboro, NC 27534-9417
Phone (919) 580-0004

Other identifiers 2

IdentifierTypeStateIssuer
8102439MedicaidNC
12242127OtherCAQH #

Other names 1

  • Jessica E Elder Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jnewman263959@direct.UNC.nchie.net Direct
Direct Messaging Address jnewman263959@direct.UNC.nchie.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20110427000480 NC Practitioner - Physician Assistant 1658556162 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

485 Valley Rd
Mocksville, NC 27028-2074
Phone (336) 751-8000

6301 Stadium Dr
Clemmons, NC 27012-8766
Phone (336) 766-6473

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
001002821NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Forsyth Memorial Hospital, Inc. CurrentSince Feb 20, 2023 Accepting new patients
Forsyth Memorial Hospital, Inc Past Accepting new patients

Locations

6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473

291 Broad St
Kernersville, NC 27284
Phone (336) 993-8181

485 Valley Rd
Mocksville, NC 27028
Phone (336) 751-8000

100 Robinhood Medical Plz
Winston Salem, NC 27106
Phone (336) 718-0560

Interoperability endpoints

  • Direct secure messaging: jnewman1108219@direct.novanthealth.org
  • Direct secure messaging: jnewman263959@direct.unc.nchie.net

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1300233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678752000000",
    "number": "1205135258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "485 VALLEY RD",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270282074",
            "telephone_number": "336-751-8000",
            "fax_number": "336-751-8010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1617 N Main St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Fuquay Varina",
            "state": "NC",
            "postal_code": "275269021",
            "country_code": "US",
            "telephone_number": "919-577-9952",
            "fax_number": "919-577-9946",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2604 Medical Office Pl",
            "address_purpose": "LOCATION",
            "city": "Goldsboro",
            "state": "NC",
            "postal_code": "275349417",
            "country_code": "US",
            "telephone_number": "919-580-0004",
            "fax_number": "919-580-9099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NEWMAN",
        "first_name": "JESSICA",
        "middle_name": "ELEANOR",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-16",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "001002821",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8102439",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH #",
            "identifier": "12242127",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jnewman263959@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1617 N Main St Ste 100",
            "city": "Fuquay Varina",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275269021",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jnewman263959@direct.UNC.nchie.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1617 N Main St Ste 100",
            "city": "Fuquay Varina",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275269021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "ELDER",
            "middle_name": "E",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mocksville, NC

Sources for this page

Verify at the official NPI Registry.