Individual provider Active NPI

Jessica Brooke Prahl, P.A.-C.

  • Physician Assistant
  • Elizabethtown, KY
National Provider Identifier
1336492677
Registry record updated Sep 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1111 Ring Rd
Suite 100
Elizabethtown, KY 42701-4900
Phone
(270) 706-5515
Fax
(270) 706-5516
NPI assigned
Oct 24, 2012
Last updated
Sep 19, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1111 Ring Rd
Suite 100
Elizabethtown, KY 42701-4900

Mailing address

PO Box 2309
Elizabethtown, KY 42702-2309
Phone (270) 706-5515

Other identifiers 1

IdentifierTypeStateIssuer
7100255980MedicaidKY

Other names 1

  • Jessica Brooke Gusler Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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

Enrollment IDStateProvider typePAC IDDetails
I20130626000498 KY Practitioner - Physician Assistant 2961656343 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Lincoln Memorial University Medical Department, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baptist Health Medical Group IncGroup PAC ID 5597867184, 2,431 clinicians

Practice addresses (Care Compare)

200 Cardinal Dr
Elizabethtown, KY 42701-2787

2603 Kentucky Ave
Suite 304
Paducah, KY 42003-3829
Phone (270) 415-4800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.29 of 100Reported as apm
Quality
87.32
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Pain Associates PLLC CurrentSince Nov 1, 2020 Accepting new patients
Commonwealth Pain Associates, PLLC Physician Assistant CurrentSince Nov 1, 2020 Accepting new patients
Baptist Health Medical Group Inc Physician Assistant CurrentSince Sep 1, 2020 Accepting new patients
Baptist Health Medical Group Inc CurrentSince Sep 1, 2020 Accepting new patients

Locations

1111 Ring Rd
Ste 100
Elizabethtown, KY 42701
Phone (270) 706-5515

913 N Dixie Ave
Elizabethtown, KY 42701
Phone (270) 706-1212

223 Executive Park
Louisville, KY 40207

2603 Kentucky Ave
Ste 304
Paducah, KY 42003
Phone (270) 415-4800

120 Executive Park
St Matthews, KY 40207
Phone (502) 409-9925

Organizations & group practices 4

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1351036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474243200000",
    "number": "1336492677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2309",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427022309",
            "telephone_number": "270-706-5515",
            "fax_number": "270-706-5516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 RING RD",
            "address_2": "SUITE 100",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427014900",
            "telephone_number": "270-706-5515",
            "fax_number": "270-706-5516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRAHL",
        "first_name": "JESSICA",
        "middle_name": "BROOKE",
        "name_prefix": "Ms.",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-24",
        "last_updated": "2016-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100255980",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "GUSLER",
            "middle_name": "BROOKE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Elizabethtown, KY

Sources for this page

Verify at the official NPI Registry.