NPIMap

Individual provider Active NPI

Jason S Urso, REGISTERED PA

  • Physician Assistant
  • Concord, NC
National Provider Identifier
1205812666
Registry record updated Apr 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-02122 Issued in NC
Practice address
920 Church St N
Concord, NC 28025-2927
Phone
(704) 403-1430
Fax
(704) 403-1158
NPI assigned
Dec 19, 2005
Last updated
Apr 8, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2022

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 0010-02122 NC Primary
Medical Physician Assistant 363AM0700X 0010-02122 NC

Addresses

Primary practice location

920 Church St N
Concord, NC 28025-2927

Mailing address

PO Box 2000
Concord, NC 28026-2000
Phone (704) 403-1430

Other practice location 1

1085 NE Gateway Ct NE
Concord, NC 28025-2406
Phone (704) 403-2525

Other identifiers 1

IdentifierTypeStateIssuer
5489L1OtherNYLEGACY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100827000859 NC Practitioner - Physician Assistant 0941271902 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atrium Health Specialty Network IncGroup PAC ID 5193245801, 248 clinicians

Practice addresses (Care Compare)

4525 Cameron Valley Pkwy
Charlotte, NC 28211-4369
Phone (704) 468-8874

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010-02122NCMDMedical Physician Assistant

Interoperability endpoints

  • Direct secure messaging: jurso210609@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 3

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 10

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": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649376000000",
    "number": "1205812666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2000",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280262000",
            "telephone_number": "704-403-1430",
            "fax_number": "704-403-1158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 CHURCH ST N",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252927",
            "telephone_number": "704-403-1430",
            "fax_number": "704-403-1158"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1085 NE Gateway Ct NE",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NC",
            "postal_code": "280252406",
            "country_code": "US",
            "telephone_number": "704-403-2525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "URSO",
        "first_name": "JASON",
        "middle_name": "S",
        "name_prefix": "Mr.",
        "credential": "REGISTERED PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-19",
        "last_updated": "2022-04-08",
        "certification_date": "2022-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-02122",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-02122",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LEGACY",
            "identifier": "5489L1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

Verify at the official NPI Registry.