Jennifer Leigh Carlquist, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12028 Issued in GA

Practice address

1700 Hospital South Dr Ste 409
Austell, GA 30106-8159

Phone

(770) 732-9100

Fax

(678) 819-0359

NPI assigned

Aug 13, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Ms. Jennifer Leigh Case Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA, GA2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Svmhs Clinics 258 clinicians

Wellstar Medical Group LLC 3,059 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Salinas Valley Health Medical Center Hospital, Salinas, CA, CCN 050334
• Wellstar Cobb Medical Center Hospital, Austell, GA, CCN 110143

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jcarlquist11371@direct.svmh.com

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.

• Svmhs Clinics

  • Multi-Specialty Clinic/Center
  • Salinas, CA
  • NPI 1093158347

  CA

  Medicare reassignment Care Compare group NPD
• Wellstar Medical Group, LLC

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003

  GA

  Medicare reassignment Care Compare group
• Community Hospital of the Monterey Peninsula

  • General Acute Care Hospital
  • Monterey, CA
  • NPI 1225285810

  CA

  Medicare reassignment NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  Care Compare group NPD
• Cep America - California

  • Emergency Medicine Physician
  • San Francisco, CA
  • NPI 1023063542

  CA

  Medicare reassignment
• Culver Emergency Medical Group

  • Emergency Medicine Physician
  • Culver City, CA
  • NPI 1699907923

  CA

  Medicare reassignment
• Monterey Bay Observation Medicine

  • Emergency Medicine Physician
  • Monterey, CA
  • NPI 1205225505

  CA

  Medicare reassignment
• Salinas Valley Emergency Medical Group, Inc

  • Emergency Medicine Physician
  • Salinas, CA
  • NPI 1174552756

  CA

  Medicare reassignment
• Wellstar Medical Group, LLC

  • Otolaryngology Physician
  • Marietta, GA
  • NPI 1881990455
  NPD
• Cep America - California

  • Emergency Medicine Physician
  • Manteca, CA
  • NPI 1316693187
  NPD
• Community Hospital of the Monterey Peninsula

  • General Acute Care Hospital
  • Monterey, CA
  • NPI 1932197258
  NPD
• Lancelot O Alexander MD a Medical Corporation

  • Specialist
  • Salinas, CA
  • NPI 1134279532
  NPD (past)

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

• Cobb Hospital, Inc

  • General Acute Care Hospital
  • Austell, GA
  • NPI 1467420448

  Hospital

  Care Compare affiliation
• Salinas Valley Memorial Healthcare System

  • Rural Health Clinic/Center
  • Gonzales, CA
  • NPI 1437549284

  Hospital

  Care Compare affiliation
• Salinas Valley Memorial Healthcare System

  • General Acute Care Hospital
  • Salinas, CA
  • NPI 1750384079

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1186963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715904000000",
    "number": "1306038591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 HOSPITAL SOUTH DR STE 409",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301068159",
            "telephone_number": "770-732-9100",
            "fax_number": "678-819-0359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 HOSPITAL SOUTH DR STE 409",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301068159",
            "telephone_number": "770-732-9100",
            "fax_number": "678-819-0359"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 E Romie Ln",
            "address_purpose": "LOCATION",
            "city": "Salinas",
            "state": "CA",
            "postal_code": "939014029",
            "country_code": "US",
            "telephone_number": "831-759-1840",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARLQUIST",
        "first_name": "JENNIFER",
        "middle_name": "LEIGH",
        "name_prefix": "Ms.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-13",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA 19294",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "12028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jcarlquist541320@directwellstar.org",
            "affiliation": "N",
            "address_1": "1700 Hospital South Dr Ste 409",
            "city": "Austell",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301068159",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "CASE",
            "middle_name": "LEIGH",
            "prefix": "MS.",
            "credential": "EMTP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Austell, GA
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.