Erica Rose Liss Conklin

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

104 Crepe Myrtle LN
Jamestown, NC 27282-8866

Phone

(630) 659-8147

NPI assigned

Feb 18, 2022

Last updated

Feb 18, 2022By 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 NC

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

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Wake Forest Emergency Providers

  • Multi-Specialty Clinic/Center
  • Statesville, NC
  • NPI 1396216735
  Medicare reassignment

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

{
    "created_epoch": "1645142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645142400000",
    "number": "1336894252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 CREPE MYRTLE LN",
            "city": "JAMESTOWN",
            "state": "NC",
            "postal_code": "272828866",
            "telephone_number": "630-659-8147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 CREPE MYRTLE LN",
            "city": "JAMESTOWN",
            "state": "NC",
            "postal_code": "272828866",
            "telephone_number": "630-659-8147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONKLIN",
        "first_name": "ERICA",
        "middle_name": "ROSE LISS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-18",
        "last_updated": "2022-02-18",
        "certification_date": "2022-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Foster Campbell, LPC
• Mikala Catalano, PHARMD
• Sidney Michelle Chadwick
• Charles L Brandenburg III DDS
• David Coleman, M.A.
• Maria Isaac Cook, LCSWA
• Amy Elizabeth Cooke, OTR/L
• Jennifer Ashley Corder, PHARMD
• Cornerstone Health Care LLC (Cornerstone Internal Medicine Premier at Jamestown)
• Paul Edward Craft, PA

• Physician Assistant in Jamestown, NC
• Providers in Jamestown, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2022; 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.