Jacki Renee Depanfilis, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

MA055834 Issued in PA

Practice address

104 Metoxet St
Suite a
Ridgway, PA 15853-1932

Phone

(814) 772-8122

Fax

(814) 772-7278

NPI assigned

Oct 23, 2012

Last updated

Apr 27, 2016By the provider in NPPES

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 names 1

• Jacki Renee Davison Former name

Medicare fee-for-service enrollment

Enrolled in PA

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

Practice roles

Locations

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.

• Dubois Regional Medical Center

  • Internal Medicine Physician
  • Du Bois, PA
  • NPI 1679584742
  Medicare reassignment NPD

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

{
    "created_epoch": "1350950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461715200000",
    "number": "1245583665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 METOXET ST",
            "address_2": "SUITE A",
            "city": "RIDGWAY",
            "state": "PA",
            "postal_code": "158531932",
            "telephone_number": "814-772-8122",
            "fax_number": "814-772-7278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 METOXET ST",
            "address_2": "SUITE A",
            "city": "RIDGWAY",
            "state": "PA",
            "postal_code": "158531932",
            "telephone_number": "814-772-8122",
            "fax_number": "814-772-7278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEPANFILIS",
        "first_name": "JACKI",
        "middle_name": "RENEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-23",
        "last_updated": "2016-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA055834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKI",
            "last_name": "DAVISON",
            "middle_name": "RENEE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joseph Christian Cole, DMD
• Joseph G Coroso, M.D.
• Devin Davis
• Elizabeth Susan Delullo, LPC
• Erica Nicole Delullo
• Michael Francis Depanfilis, R.PH.
• Kara Detsch
• Dickinson Center, Inc
• Dickinson Center, Inc
• Dickinson Center, Inc/Autism OT

• Medical Physician Assistant in Ridgway, PA
• Providers in Ridgway, PA by specialty
• Medical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2016; 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.