Jessica Brianne Dettman, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1023 W Highway 30
Gonzales, LA 70737-5002

Phone

(225) 743-2366

Fax

(225) 743-2369

NPI assigned

Jun 27, 2018

Last updated

Feb 21, 2020By 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

Medicare fee-for-service enrollment

Enrolled in LA

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

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PCP Urgent Care Holdings LLCGroup PAC ID 5092016816, 47 clinicians

Practice addresses (Care Compare)

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.

• PCP Urgent Care Holdings LLC

  dba Patient Plus Urgent Care

  • Urgent Care Clinic/Center
  • Baton Rouge, LA
  • NPI 1245601038
  Medicare reassignment Care Compare group NPD
• PCP Urgent Care Holdings LLC

  dba Patient Plus Urgent Care

  • Durable Medical Equipment & Medical Supplies
  • New Orleans, LA
  • NPI 1598657025
  NPD
• R.T. Royal Group LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Baton Rouge, LA
  • NPI 1255705828
  NPD (past)

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

{
    "created_epoch": "1530057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582243200000",
    "number": "1306331814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1023 W HIGHWAY 30",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707375002",
            "telephone_number": "225-743-2366",
            "fax_number": "225-743-2369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1023 W HIGHWAY 30",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707375002",
            "telephone_number": "225-743-2366",
            "fax_number": "225-743-2369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETTMAN",
        "first_name": "JESSICA",
        "middle_name": "BRIANNE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-27",
        "last_updated": "2020-02-21",
        "certification_date": "2020-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Whitney A Delmore, LCSW
• Shannon Dennis
• Caitlin Todd Denton, DDS
• Jacob P Deprimo, LCSW
• Monique Desvignes, PHARMD
• Maggie Deville, SLP-CCC
• Emily Ann Devillier
• Michael A Dicarlo, PTA
• Daphne Zimmer Dicharry, P.T.
• Allison Dimattia, PT, DPT

• Physician Assistant in Gonzales, LA
• Providers in Gonzales, LA by specialty
• Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 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.
• 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.