Individual provider Active NPI

Jessica Miller, P.A.

  • Surgical Physician Assistant
  • Charlottesville, VA
National Provider Identifier
1386096162
Registry record updated Jun 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
0110-005401 Issued in VA
Practice address
595 Martha Jefferson Dr Ste 180
Charlottesville, VA 22911-4669
Phone
(434) 654-5575
Fax
(434) 654-5574
NPI assigned
Jul 6, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 0110-005401 VA Primary

Addresses

Primary practice location

595 Martha Jefferson Dr Ste 180
Charlottesville, VA 22911-4669

Mailing address

PO Box 746550
Atlanta, GA 30374-6550
Phone (888) 236-2263

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, VA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20181213001597 NC Practitioner - Physician Assistant 5799020160 Reassigns benefits to 1 organization
I20220523002071 VA Practitioner - Physician Assistant 5799020160 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Martha Jefferson Medical Group LLCGroup PAC ID 5991889081, 197 clinicians

Practice addresses (Care Compare)

Charlottesville, VA 22911

1646 Park Ridge Dr
Crozet, VA 22932-3155
Phone (434) 654-2760

3263 Proffit Rd
Charlottesville, VA 22911-5639

595 Martha Jefferson Dr
Charlottesville, VA 22911-4669

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0110-005401VAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Vidant Medical Group LLC CurrentSince Nov 26, 2018 Accepting new patients

Locations

503 Bowman Gray Dr
Greenville, NC 27834
Phone (252) 816-0600

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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": "1467763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655164800000",
    "number": "1386096162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746550",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746550",
            "telephone_number": "888-236-2263",
            "fax_number": "434-654-5574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 MARTHA JEFFERSON DR STE 180",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229114669",
            "telephone_number": "434-654-5575",
            "fax_number": "434-654-5574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "JESSICA",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-06",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "VA",
            "license": "0110-005401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlottesville, VA

Sources for this page

Verify at the official NPI Registry.