Individual provider Active NPI

Jadyn Novak, PA-C

  • Family Medicine Physician
  • Weaverville, CA
National Provider Identifier
1457245086
Registry record updated Oct 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
PA66491 Issued in CA
Practice address
PO Box 1229
Weaverville, CA 96093-1229
Phone
(530) 623-2687
NPI assigned
Jun 6, 2025
Last updated
Oct 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X PA66491 CA Primary

Addresses

Primary practice location

PO Box 1229
Weaverville, CA 96093-1229

Mailing address

45585 146TH St
Summit, SD 57266-5205
Phone (605) 949-1371

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20251110000938 CA Order and Referring Only - Physician Assistant 6204326069

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA66491CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain Communities Healthcare Dist Past Accepting new patients
Mountain Communities Healthcare District Past Accepting new patients

Organizations & group practices 2

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": "1749168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760659200000",
    "number": "1457245086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45585 146TH ST",
            "city": "SUMMIT",
            "state": "SD",
            "postal_code": "572665205",
            "telephone_number": "605-949-1371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 1229",
            "city": "WEAVERVILLE",
            "state": "CA",
            "postal_code": "960931229",
            "telephone_number": "530-623-2687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOVAK",
        "first_name": "JADYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-06",
        "last_updated": "2025-10-17",
        "certification_date": "2025-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "PA66491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Weaverville, CA

Sources for this page

Verify at the official NPI Registry.