Individual provider Active NPI

Eric Jacala, PA-C

  • Physician Assistant
  • Philadelphia, PA
National Provider Identifier
1386018398
Registry record updated Mar 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA058233 Issued in PA
Practice address
800 Spruce Street
1 Cathcart
Philadelphia, PA 19107-6130
Phone
(215) 662-3340
Fax
(215) 349-5890
NPI assigned
Nov 16, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 25MP00384100 NJ
Physician Assistant 363A00000X MA058233 PA Primary

Addresses

Primary practice location

800 Spruce Street
1 Cathcart
Philadelphia, PA 19107-6130

Mailing address

800 Spruce Street
1 Cathcart
Philadelphia, PA 19107-6130
Phone (215) 662-3340

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20180629000033 PA Practitioner - Physician Assistant 5698021947 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MP00384100NJMDPhysician Assistant
MA058233PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group CurrentSince Mar 1, 2021 Accepting new patients
University of Penn-Medical Group CurrentSince Mar 1, 2021 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health CurrentSince Mar 1, 2022 Accepting new patients
Clinical Care Associates of the University of CurrentSince Mar 1, 2022 Accepting new patients
Clinical Care Associates of the University of Pennsylvania Health Syst Past Accepting new patients

Locations

800 Spruce St
#1W
Philadelphia, PA 19107
Phone (215) 829-7817

800 Spruce St
#1
William Penn Annex West, PA 19107
Phone (215) 829-2222

777 Township Line Rd
Ste 200
Yardley, PA 19067
Phone (215) 860-0775

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1447632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614556800000",
    "number": "1386018398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 SPRUCE STREET",
            "address_2": "1 CATHCART",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191076130",
            "telephone_number": "215-662-3340",
            "fax_number": "215-349-5890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 SPRUCE STREET",
            "address_2": "1 CATHCART",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191076130",
            "telephone_number": "215-662-3340",
            "fax_number": "215-349-5890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACALA",
        "first_name": "ERIC",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-11-16",
        "last_updated": "2021-03-01",
        "certification_date": "2021-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00384100",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA058233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.