Individual provider Active NPI

Jessica Bradshaw, PA

  • Surgical Physician Assistant
  • Memphis, TN
National Provider Identifier
1407391055
Registry record updated Jan 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
3221 Issued in TN
Practice address
6286 Briarcrest Ave Ste 200
Memphis, TN 38120-4023
Phone
(901) 641-3000
Fax
(901) 259-1698
NPI assigned
Jan 5, 2017
Last updated
Jan 10, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 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 3221 TN
Medical Physician Assistant 363AM0700X 3221 TN
Surgical Physician Assistant 363AS0400X 3221 TN Primary

Addresses

Primary practice location

6286 Briarcrest Ave Ste 200
Memphis, TN 38120-4023

Mailing address

6077 Primacy Pkwy Ste 140
Memphis, TN 38119-5742
Phone (901) 259-1600

Other practice location 1

2100 Exeter Rd Ste 200
Germantown, TN 38138-3966
Phone (901) 641-3000

Other practice location 2

262 Danny Thomas Pl
Memphis, TN 38105-3678
Phone (901) 595-3300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS2 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
I20170628001785 TN Practitioner - Physician Assistant 9234408659 Reassigns benefits to 1 organization
I20170808002045 MS Practitioner - Physician Assistant 9234408659 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
MSK Group PCGroup PAC ID 4688574262, 138 clinicians

Practice addresses (Care Compare)

2100 Exeter Rd
Suite 200
Germantown, TN 38138-3966
Phone (901) 641-3000

6286 Briarcrest Ave
Memphis, TN 38120-4023

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3221TNMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
MSK Group, PC CurrentSince Mar 4, 2017 Accepting new patients
MSK Group, PC Surgical CurrentSince Mar 4, 2017 Accepting new patients
MSK Group PC CurrentSince May 25, 2017 Accepting new patients

Locations

7580 Clarington Cv
Southaven, MS 38671
Phone (901) 259-1600

2100 Exeter Rd
Ste 200
Germantown, TN 38138
Phone (901) 522-6440

6077 E Primacy Pkwy
Ste 140
Memphis, TN 38119
Phone (901) 725-8347

6286 Briarcrest Ave
#200
Memphis, TN 38120
Phone (901) 259-1600

6286 Briarcrest Ave
Ste 100
Memphis, TN 38120
Phone (901) 259-1600

6286 Briarcrest Ave
Ste 200
Memphis, TN 38120
Phone (901) 259-1600

Interoperability endpoints

  • Direct secure messaging: jbradshaw27270@mlh.direct-ci.com

Organizations & group practices 3

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.

Hospital & facility affiliations 4

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": "1483574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736467200000",
    "number": "1407391055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6077 PRIMACY PKWY STE 140",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381195742",
            "telephone_number": "901-259-1600",
            "fax_number": "901-259-1698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6286 BRIARCREST AVE STE 200",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381204023",
            "telephone_number": "901-641-3000",
            "fax_number": "901-259-1698"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2100 Exeter Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Germantown",
            "state": "TN",
            "postal_code": "381383966",
            "country_code": "US",
            "telephone_number": "901-641-3000",
            "fax_number": "901-373-3804",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "262 Danny Thomas Pl",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381053678",
            "country_code": "US",
            "telephone_number": "901-595-3300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRADSHAW",
        "first_name": "JESSICA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-05",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "3221",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "3221",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "3221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.