Individual provider Active NPI

Jessica Atkinson, PA

  • Physician Assistant
  • Tyler, TX
National Provider Identifier
1467829440
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA10251 Issued in TX
Practice address
5414 S Broadway Ave
Tyler, TX 75703-1335
Phone
(903) 581-1601
NPI assigned
Aug 26, 2015
Last updated
Aug 7, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

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 PA10251 TX Primary
Physician Assistant 363A00000X PA.0008687 CO
Medical Physician Assistant 363AM0700X

Addresses

Primary practice location

5414 S Broadway Ave
Tyler, TX 75703-1335

Mailing address

PO Box 841656
Dallas, TX 75284-1656
Phone (903) 531-5000

Other practice location 1

8389 S Broadway Ave
Tyler, TX 75703-5408
Phone (903) 606-6500

Other practice location 2

18780 Interstate 20
Canton, TX 75103-3593
Phone (903) 567-4841

Other practice location 3

520 Douglas Blvd
Tyler, TX 75702-8307
Phone (903) 606-6400

Other practice location 4

2026 S Jackson St
Jacksonville, TX 75766-5822
Phone (903) 541-4500

Other practice location 5

800 E Dawson St
Tyler, TX 75701-2036
Phone (903) 606-4262

Other practice location 6

20208 State Highway 155 S
Flint, TX 75762-5600
Phone (903) 825-6222

Other practice location 7

3203 S Main St
Lindale, TX 75771-7727
Phone (903) 266-4000

Other practice location 8

115 Airport Rd
Sulphur Springs, TX 75482-2105
Phone (903) 885-7671

Other practice location 9

2222 N Nevada Ave
Colorado Springs, CO 80907-6819
Phone (719) 776-8040

Other identifiers 19

IdentifierTypeStateIssuer
8492NYOtherTXBCBS
P01719711OtherTXRAIL ROAD MEDICARE
351895303MedicaidTX
75-2616977-028OtherTXTRICARE
75-0818167-044OtherTXTRICARE
8493NYOtherTXBCBS
8627NYOtherTXBCBS
P01707527OtherTXRAIL ROAD MEDICARE
351895305MedicaidTX
75-0818167-022OtherTXTRICARE
75-2616977-002OtherTXTRICARE
75-2616977-041OtherTXTRICARE
75-0818167-048OtherTXTRICARE
351895304MedicaidTX
351895306MedicaidTX
75-0818167-015OtherTXTRICARE
75-1976930-005OtherTXTRICARE
8491NYOtherTXBCBS
P01719714OtherTXRAIL ROAD MEDICARE

Other names 1

  • Jessica Picinich Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CO2 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
I20151028001725 TX Practitioner - Physician Assistant 6305155508 Reassigns benefits to 6 organizations
I20240828003440 CO Practitioner - Physician Assistant 6305155508 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Catholic Health Initiatives ColoradoGroup PAC ID 8022927342, 1,230 clinicians

Practice addresses (Care Compare)

41 State Hwy 67
Woodland Park, CO 80863-5008
Phone (719) 776-4780

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.0008687COMDPhysician Assistant
PA10251TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas CurrentSince Aug 22, 2016 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince Aug 22, 2016 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Aug 22, 2016 Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Oct 1, 2024 Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Oct 1, 2024 Accepting new patients

Locations

9100 E Mineral Cir
Centennial, CO 80112
Phone (303) 561-5193

2222 N Nevada Ave
Colorado Springs, CO 80907
Phone (719) 776-5333

41 State Highway 67
Woodland Park, CO 80863
Phone (719) 686-0551

20208 State Highway 155 S
Flint, TX 75762
Phone (903) 825-6222

2026 S Jackson St
Jacksonville, TX 75766
Phone (903) 541-4500

3203 S Main St
Lindale, TX 75771
Phone (903) 266-4000

700 E Marshall Ave
Longview, TX 75601
Phone (903) 236-2000

115 Airport Rd
Sulphur Springs, TX 75482
Phone (903) 439-4052

520 Douglas Blvd
Tyler, TX 75702
Phone (903) 510-1175

5414 S Broadway Ave
Tyler, TX 75703
Phone (903) 581-1601

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018

8389 S Broadway Ave
Tyler, TX 75703
Phone (903) 606-4129

Organizations & group practices 10

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 2

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": "1440547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722988800000",
    "number": "1467829440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 841656",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752841656",
            "telephone_number": "903-531-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5414 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031335",
            "telephone_number": "903-581-1601"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8389 S Broadway Ave",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757035408",
            "country_code": "US",
            "telephone_number": "903-606-6500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18780 Interstate 20",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "TX",
            "postal_code": "751033593",
            "country_code": "US",
            "telephone_number": "903-567-4841",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "520 Douglas Blvd",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757028307",
            "country_code": "US",
            "telephone_number": "903-606-6400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2026 S Jackson St",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "TX",
            "postal_code": "757665822",
            "country_code": "US",
            "telephone_number": "903-541-4500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 E Dawson St",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757012036",
            "country_code": "US",
            "telephone_number": "903-606-4262",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20208 State Highway 155 S",
            "address_purpose": "LOCATION",
            "city": "Flint",
            "state": "TX",
            "postal_code": "757625600",
            "country_code": "US",
            "telephone_number": "903-825-6222",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3203 S Main St",
            "address_purpose": "LOCATION",
            "city": "Lindale",
            "state": "TX",
            "postal_code": "757717727",
            "country_code": "US",
            "telephone_number": "903-266-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "115 Airport Rd",
            "address_purpose": "LOCATION",
            "city": "Sulphur Springs",
            "state": "TX",
            "postal_code": "754822105",
            "country_code": "US",
            "telephone_number": "903-885-7671",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2222 N Nevada Ave",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809076819",
            "country_code": "US",
            "telephone_number": "719-776-8040",
            "fax_number": "719-776-8050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ATKINSON",
        "first_name": "JESSICA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-26",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA10251",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0008687",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8492NY",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P01719711",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "351895303",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-028",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-0818167-044",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8493NY",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8627NY",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P01707527",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "351895305",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-0818167-022",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-002",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-041",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-0818167-048",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "351895304",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "351895306",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-0818167-015",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-1976930-005",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8491NY",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P01719714",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "PICINICH",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.