Active NPI
Jared Toller
- Medical Physician Assistant
- Henderson, NV
National Provider Identifier
1396341293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA2770
- Practice address
- 93 Moon Hill Dr
Henderson, NV 89011-3799 - Phone
- (818) 825-1733
- NPI assigned
- Dec 7, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 59134 | CA | |
| Medical Physician Assistant | 363AM0700X | 13382949-1206 | UT | |
| Medical Physician Assistant | 363AM0700X | PA2770 | NV | Primary |
Addresses
Primary practice location
93 Moon Hill Dr
Henderson, NV 89011-3799
Mailing address
93 Moon Hill Dr
Henderson, NV 89011-3799
Phone (818) 825-1733
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 59134 | CA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
| PA2770 | NV | MD | Medical Physician Assistant |
| 13382949-1206 | UT | MD | Medical Physician Assistant |
Interoperability endpoints
- jared.toller.1@16948.direct.athenahealth.com
Organizations & group practices 1
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": "1607299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683504000000",
"number": "1396341293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "93 MOON HILL DR",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890113799",
"telephone_number": "818-825-1733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "93 MOON HILL DR",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890113799",
"telephone_number": "818-825-1733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TOLLER",
"first_name": "JARED",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-07",
"last_updated": "2023-05-08",
"certification_date": "2023-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CA",
"license": "59134",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "UT",
"license": "13382949-1206",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NV",
"license": "PA2770",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.