Individual provider Active NPI

Jessica E Paonessa, MD

  • Urology Physician
  • Traverse City, MI
National Provider Identifier
1386760122
Registry record updated Sep 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
4301113807 Issued in MI
Practice address
1221 Sixth St Ste 100
Traverse City, MI 49684
Phone
(231) 935-0322
Fax
(231) 935-0334
NPI assigned
Mar 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 274692 NY
Urology Physician 208800000X 01071233A IN
Urology Physician 208800000X 4301113807 MI Primary

Addresses

Primary practice location

1221 Sixth St Ste 100
Traverse City, MI 49684

Mailing address

1221 Sixth St Ste 100
Traverse City, MI 49684-2359
Phone (231) 935-0322

Other practice location 1

4900 Broad Rd
Syracuse, NY 13215
Phone (315) 492-3700

Other identifiers 3

IdentifierTypeStateIssuer
03884526MedicaidNY
201112070MedicaidIN
000000792827OtherINANTHEM PIN

Other names 1

  • Ms. Jessica Erin Stevens Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171211002961 MI Practitioner - Urology 2567601495 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Wayne State University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Munson Medical CenterGroup PAC ID 3072426287, 377 clinicians

Practice addresses (Care Compare)

3922 Cedar Run Rd
Bay Area
Traverse City, MI 49684-9687
Phone (231) 935-0322

Hospital & facility affiliations

  • Munson Medical Center Hospital, Traverse City, MI, CCN 230097
  • Munson Healthcare Cadillac Hospital Hospital, Cadillac, MI, CCN 230081
  • Kalkaska Memorial Health Center Hospital, Kalkaska, MI, CCN 231301
  • Munson Healthcare Manistee Hospital Hospital, Manistee, MI, CCN 230303
  • Paul Oliver Memorial Hospital Hospital, Frankfort, MI, CCN 231300

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection35

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301113807MIMDUrology Physician
274692NYMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Center CurrentSince Nov 8, 2017 Accepting new patients
Munson Medical Center Urology CurrentSince Nov 8, 2017 Accepting new patients
Munson Medical Center Current Accepting new patients
Munson Medical Center Past Accepting new patients

Locations

2513 Momentum Pl
Chicago, IL 60689
Phone (231) 935-8031

400 Hobart St
Cadillac, MI 49601
Phone (231) 876-7200

3922 Cedar Run Rd
Traverse City, MI 49684
Phone (231) 392-0430

1221 Sixth St
Ste 100
Traverse City, MI 49684
Phone (231) 392-8400

1400 Medical Campus Dr
Traverse City, MI 49684
Phone (231) 935-8000

Interoperability endpoints

  • Direct secure messaging: jpaonessa@direct.mhc.net

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1386760122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 SIXTH ST STE 100",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842359",
            "telephone_number": "231-935-0322",
            "fax_number": "231-935-0334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 SIXTH ST STE 100",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49684",
            "telephone_number": "231-935-0322",
            "fax_number": "231-935-0334"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4900 Broad Rd",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "13215",
            "country_code": "US",
            "telephone_number": "315-492-3700",
            "fax_number": "315-492-3596",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAONESSA",
        "first_name": "JESSICA",
        "middle_name": "E",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-22",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NY",
            "license": "274692",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IN",
            "license": "01071233A",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MI",
            "license": "4301113807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03884526",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201112070",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN",
            "identifier": "000000792827",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "STEVENS",
            "middle_name": "ERIN",
            "prefix": "MS.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.