Jenna Christina Distasio, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2229 Issued in MA

Practice address

91 Parker Hill Ave
Roxbury Crossing, MA 02120-3215

Phone

(617) 754-6742

Fax

(617) 754-6443

NPI assigned

May 25, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

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

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.

• Boston Orthopaedic and Spine LLC

  • Orthopaedic Surgery Physician
  • Brighton, MA
  • NPI 1619507043
  Medicare reassignment
• Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc

  dba Orthopedic Surgery - HMFP at BIDMC

  • Orthopaedic Surgery Physician
  • Boston, MA
  • NPI 1972544591
  NPD (past)

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597795200000",
    "number": "1215148606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 GUEST ST",
            "address_2": "STE 225",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021352065",
            "telephone_number": "617-738-8642",
            "fax_number": "617-202-4172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 PARKER HILL AVE",
            "city": "ROXBURY CROSSING",
            "state": "MA",
            "postal_code": "021203215",
            "telephone_number": "617-754-6742",
            "fax_number": "617-754-6443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISTASIO",
        "first_name": "JENNA",
        "middle_name": "CHRISTINA",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-25",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "2229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roberto Antonio Cruz-Gervis, MD
• Brenda Louise Daley, LICSW
• David H Kim, MD PC
• Susan Davidson, M.D.
• Bianca De Anda, DDS
• Nurulla Diyanat, DMD
• Elizabeth Donato
• Janice Gail Doren, PT
• Heather A Doris, MSPT
• Douglas Patch MD PC

• Physician Assistant in Roxbury Crossing, MA
• Providers in Roxbury Crossing, MA by specialty
• Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.