NPIMap

Individual provider Active NPI

Jessica Fedie, PA-C

  • Physician Assistant
  • Greenbrae, CA
National Provider Identifier
1396179586
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
53936 Issued in CA
Practice address
250 Bon Air Rd
Greenbrae, CA 94904-1702
Phone
(415) 925-7000
NPI assigned
Aug 25, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1972 MN
Physician Assistant 363A00000X 11483 MN
Physician Assistant 363A00000X 53936 CA Primary

Addresses

Primary practice location

250 Bon Air Rd
Greenbrae, CA 94904-1702

Mailing address

250 Bon Air Rd
Greenbrae, CA 94904-1702

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20131025000001 MN Practitioner - Physician Assistant 2961636345 Reassigns benefits to 1 organization
I20170918003554 CA Practitioner - Physician Assistant 2961636345 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
May accept Medicare assignment
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians
Regents Univ of California UCSFGroup PAC ID 6305160300, 276 clinicians

Practice addresses (Care Compare)

1165 Montgomery Dr
Santa Rosa, CA 95405-4801
Phone (707) 546-3210

500 Doyle Park Dr
Santa Rosa, CA 95405-4559

505 Parnassus Ave
San Francisco, CA 94143-2204
Phone (415) 476-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1972MNMDMarriage & Family Therapist
53936CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. CurrentSince Jun 1, 2019 Accepting new patients
Providence Medical Foundation CurrentSince Oct 1, 2023 Accepting new patients
Group Health, Inc. CurrentSince Jun 1, 2019 Accepting new patients
Providence Medical Foundation CurrentSince Oct 1, 2023 Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Regions Hospital Past Accepting new patients
Providence Medical Foundation Past Accepting new patients

Locations

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

1165 Montgomery Dr
Santa Rosa, CA 95405
Phone (707) 525-5300

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

333 Smith Ave N
Saint Paul, MN 55102
Phone (651) 220-8256

Interoperability endpoints

  • Direct secure messaging: jfedie386436@direct-ucsfmedicalcenter.org

Organizations & group practices 9

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 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": "1377388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1396179586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 BON AIR RD",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "949041702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 BON AIR RD",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "949041702",
            "telephone_number": "415-925-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDIE",
        "first_name": "JESSICA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-25",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "1972",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11483",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "53936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenbrae, CA

Sources for this page

Verify at the official NPI Registry.