Active NPI
Jill F Henritze, PA-C
- Physician Assistant
- Bristol, VA
National Provider Identifier
1255376190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA0000001029
- Practice address
- 811 State St
Bristol, VA 24201-4143 - Phone
- (276) 469-8899
- Fax
- (276) 469-8904
- NPI assigned
- Jun 17, 2006
- Last updated
- Mar 30, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA0000001029 | TN | Primary |
Addresses
Primary practice location
811 State St
Bristol, VA 24201-4143
Mailing address
811 State St
Bristol, VA 24201-4143
Phone (276) 469-8899
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255376190 | Medicaid | VA | |
| PA0001029 | Other | TN | LICENSE |
| 3661425 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA0000001029 | TN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Associated Orthopaedics of Kingsport PC | Past | Accepting new patients |
Interoperability endpoints
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.1579
Organizations & group practices 1
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.
-
- Orthopaedic Surgery Physician
- Norton, VA
- NPI 1013273937
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680134400000",
"number": "1255376190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "811 STATE ST",
"city": "BRISTOL",
"state": "VA",
"postal_code": "242014143",
"telephone_number": "276-469-8899",
"fax_number": "276-469-8904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "811 STATE ST",
"city": "BRISTOL",
"state": "VA",
"postal_code": "242014143",
"telephone_number": "276-469-8899",
"fax_number": "276-469-8904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENRITZE",
"first_name": "JILL",
"middle_name": "F",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-17",
"last_updated": "2023-03-30",
"certification_date": "2023-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TN",
"license": "PA0000001029",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1255376190",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "PA0001029",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3661425",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bristol, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.