Jessica Panoff, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5601007439 Issued in MI

Practice address

116 W Mitchell St
Petoskey, MI 49770-2357

Phone

(231) 348-2828

Fax

(231) 348-9609

NPI assigned

Sep 21, 2015

Last updated

Dec 18, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jessica Ann Wallace Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Petoskey Urgent Care Billing PC

  • Family Medicine Physician
  • Petoskey, MI
  • NPI 1861811382
  NPD

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

{
    "created_epoch": "1442793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608249600000",
    "number": "1548639560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 W MITCHELL",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702357",
            "telephone_number": "231-348-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 W MITCHELL ST",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702357",
            "telephone_number": "231-348-2828",
            "fax_number": "231-348-9609"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "37450 Dequindre Rd",
            "address_purpose": "LOCATION",
            "city": "Sterling Heights",
            "state": "MI",
            "postal_code": "483103503",
            "country_code": "US",
            "telephone_number": "586-979-5100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1890 US Highway 131 Unit 4",
            "address_purpose": "LOCATION",
            "city": "Petoskey",
            "state": "MI",
            "postal_code": "497708344",
            "country_code": "US",
            "telephone_number": "231-487-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PANOFF",
        "first_name": "JESSICA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-21",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601007439",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1548639560",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "WALLACE",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Naomi A Overton, MD
• Dale D Owen Jr., MD
• Wilfred Vincent Pacatang, DO
• Caroline Paige, LLMSW, CADC-DP
• Harry Ted Pall Jr., M.D.
• Vincent Paone
• Sandra Ann Parker, RD
• Andrea Parsons, DO
• Diane Jussila Pateman
• Gary P Pateman, DC

• Medical Physician Assistant in Petoskey, MI
• Providers in Petoskey, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.