Individual provider Active NPI

Jensen Hodecker

  • Physician Assistant
  • Mount Laurel, NJ
National Provider Identifier
1417779562
Registry record updated Sep 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA066114 Issued in PA
Practice address
101 Gaither Dr
Mount Laurel, NJ 08054-1701
Phone
(856) 810-9888
NPI assigned
Oct 29, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA066114 PA Primary
Physician Assistant 363A00000X

Addresses

Primary practice location

101 Gaither Dr
Mount Laurel, NJ 08054-1701

Mailing address

500 N 21St St Apt 715
Philadelphia, PA 19130-4253

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA2 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
I20250102002548 NJ Practitioner - Physician Assistant 5193252146 Reassigns benefits to 1 organization
I20251118001410 PA Practitioner - Physician Assistant 5193252146 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Jersey Skin Care and Laser Center, P.C.Group PAC ID 2567426919, 7 clinicians
Pennsylvania Dermatology Partners IncGroup PAC ID 3274794268, 75 clinicians

Practice addresses (Care Compare)

101 Gaither Dr
Mount Laurel, NJ 08054-1701
Phone (856) 810-9888

10800 Knights Rd
Suite 210
Philadelphia, PA 19114-4200
Phone (610) 288-2908

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA066114PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pennsylvania Dermatology Partners Inc CurrentSince Sep 15, 2025 Accepting new patients
Deirdre Wood MD PC Physician Assistant PastSince Oct 1, 2013 Accepting new patients

Locations

1950 Street Rd
Ste 100
Bensalem, PA 19020
Phone (215) 639-7546

258 Ben Franklin Hwy E
Birdsboro, PA 19508
Phone (610) 288-2918

8001 Roosevelt Blvd
Ste 307
Philadelphia, PA 19152
Phone (267) 440-0090

9501 Roosevelt Blvd
Ste 506
Philadelphia, PA 19114
Phone (215) 676-7200

10800 Knights Rd
Ste 210
Philadelphia, PA 19114
Phone (215) 427-1111

9501 Roosevelt Blvd
Ste 508
Philadelphia, PA 19114
Phone (215) 464-7400

Interoperability endpoints

  • Direct secure messaging: jhodecker1@pennderm.emadirect.md

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1730160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757808000000",
    "number": "1417779562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N 21ST ST APT 715",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191304253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 GAITHER DR",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080541701",
            "telephone_number": "856-810-9888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HODECKER",
        "first_name": "JENSEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-29",
        "last_updated": "2025-09-14",
        "certification_date": "2025-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA066114",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Laurel, NJ

Sources for this page

Verify at the official NPI Registry.