Individual provider Active NPI

Jaclyn Mercure, PA-C

  • Physician Assistant
  • Glens Falls, NY
National Provider Identifier
1407207160
Registry record updated Jun 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
019755 Issued in NY
Practice address
3 Irongate Ctr
Glens Falls, NY 12801-3471
Phone
(518) 793-4409
NPI assigned
Jun 23, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 019755 NY Primary

Addresses

Primary practice location

3 Irongate Ctr
Glens Falls, NY 12801-3471

Mailing address

3 Irongate Ctr
Glens Falls, NY 12801-3471
Phone (518) 793-4409

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20160812001273 NY Practitioner - Physician Assistant 2264726272 Reassigns benefits to 1 organization

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: jaclynm@irongatefamilypractice.medentdirect.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1466640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466640000000",
    "number": "1407207160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 IRONGATE CTR",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "128013471",
            "telephone_number": "518-793-4409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 IRONGATE CTR",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "128013471",
            "telephone_number": "518-793-4409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERCURE",
        "first_name": "JACLYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-23",
        "last_updated": "2016-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "019755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glens Falls, NY

Sources for this page

Verify at the official NPI Registry.