Jacquelyn Johnston, PA
Individual provider Active NPI Physician Assistant · Newton, IA
NPI 1316385271 · NPPES record last updated Aug 5, 2022
Key facts
- NPI
- 1316385271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 002403 (IA)
- Practice address
- 306 N 3Rd Ave E
Newton, IA 50208-3249 - Phone
- (641) 792-4012
- Fax
- (641) 791-0697
- NPI assigned
- Jun 12, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Capstone Behavioral Healthcare Inc
Practice addresses (Care Compare)
200 4TH Ave W
Grinnell, IA 50112-1833
Phone (641) 528-6065
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130923000413 | IA | Practitioner - Physician Assistant | 7719121235 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002403 | IA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boone County Hospital | Past | Accepting new patients | |
| Poweshiek County Mental Health Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 002403 | IA | Yes |
Addresses
Primary practice location
306 N 3Rd Ave E
Newton, IA 50208-3249
Mailing address
306 N 3Rd Ave E
Newton, IA 50208-3249
Phone (641) 792-4012
Other names
- Jacquelyn Stortenbecker
NPI Registry JSON
{
"created_epoch": "1370995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659657600000",
"number": "1316385271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "306 N 3RD AVE E",
"city": "NEWTON",
"state": "IA",
"postal_code": "502083249",
"telephone_number": "641-792-4012",
"fax_number": "641-791-0697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 N 3RD AVE E",
"city": "NEWTON",
"state": "IA",
"postal_code": "502083249",
"telephone_number": "641-792-4012",
"fax_number": "641-791-0697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSTON",
"first_name": "JACQUELYN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-12",
"last_updated": "2022-08-05",
"certification_date": "2022-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IA",
"license": "002403",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JACQUELYN",
"last_name": "STORTENBECKER",
"credential": "PA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Newton, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 5, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.