NPIMap

Individual provider Active NPI

Jacqueline Eileen Davis, PA-C

  • Physician Assistant
  • Louisville, KY
National Provider Identifier
1245402262
Registry record updated Mar 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
3 Audubon Plaza Dr Ste 430
Louisville, KY 40217
Phone
(502) 636-4900
Fax
(502) 636-4901
NPI assigned
Mar 31, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2019

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 Primary

Addresses

Primary practice location

3 Audubon Plaza Dr Ste 430
Louisville, KY 40217

Mailing address

PO Box 776351
Chicago, IL 60677-6351
Phone (502) 272-5063

Other practice location 1

3 Audubon Plaza Dr Ste 430
Louisville, KY 40217
Phone (502) 636-4900

Other identifiers 2

IdentifierTypeStateIssuer
7100054590MedicaidKY
50022601OtherKYPASSPORT HEALTH PLAN

Other names 1

  • Jacqueline Eileen Fountain Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20080716000523 KY Practitioner - Physician Assistant 2769555259 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
May accept Medicare assignment
Group practices
Louisville Hip and Knee InstituteGroup PAC ID 3779990080, 18 clinicians
PT Pros, IncGroup PAC ID 0143139337, shared by 14 NPIs, 263 clinicians

Practice addresses (Care Compare)

3810 Springhurst Blvd
Suite 310
Louisville, KY 40241-6162
Phone (502) 447-5633

4031 N Dixie Hwy
Elizabethtown, KY 42701-7873
Phone (270) 982-4776

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.11 of 100Reported as group
Quality
63.34
Promoting interoperability
100
Improvement activities
40
Cost
73.68

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical Associates, Inc. CurrentSince Feb 19, 2018 Accepting new patients
Community Medical Associates, Inc. CurrentSince Feb 19, 2018 Accepting new patients

Locations

9880 Angies Way
Ste 250
Louisville, KY 40241
Phone (502) 394-6340

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

3 Audubon Plaza Dr
Ste 430
Louisville, KY 40217
Phone (502) 636-4900

Interoperability endpoints

  • Direct secure messaging: jacqueline.davis.1@22070.direct.athenahealth.com
  • Direct secure messaging: jdavis59239@direct.nortonhealthcare.org

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 and National Provider Directory roles.

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1206921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553126400000",
    "number": "1245402262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776351",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776351",
            "telephone_number": "502-272-5063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 AUDUBON PLAZA DR STE 430",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40217",
            "telephone_number": "502-636-4900",
            "fax_number": "502-636-4901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Audubon Plaza Dr Ste 430",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "40217",
            "country_code": "US",
            "telephone_number": "502-636-4900",
            "fax_number": "502-636-4901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JACQUELINE",
        "middle_name": "EILEEN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-31",
        "last_updated": "2019-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100054590",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT HEALTH PLAN",
            "identifier": "50022601",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "FOUNTAIN",
            "middle_name": "EILEEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.