NPIMap

Individual provider Active NPI

Jessica Anne Mack, PA-C

  • Neurological Surgery Physician
  • Wheeling, WV
National Provider Identifier
1548817943
Registry record updated Oct 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
2489 Issued in WV
Practice address
40 Medical Park Road Suite 508
Wheeling, WV 26003-6861
Phone
(304) 243-8916
NPI assigned
Aug 20, 2019
Last updated
Oct 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 8, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Neurological Surgery Physician 207T00000X 2489 WV Primary

Addresses

Primary practice location

40 Medical Park Road Suite 508
Wheeling, WV 26003-6861

Mailing address

40 Medical Park Road Suite 508
Wheeling, WV 26003
Phone (304) 243-8916

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, OH, PA3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20210709001671 WV Practitioner - Physician Assistant 4082016241 Reassigns benefits to 2 organizations
I20250328003093 OH Practitioner - Physician Assistant 4082016241 Reassigns benefits to 1 organization
I20260614000134 PA Practitioner - Physician Assistant 4082016241 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1 Medical Ctr Dr
Morgantown, WV 26506-1200
Phone (304) 598-4865

1 Medical Park
Wheeling, WV 26003-6379
Phone (304) 243-8630

51339 National Rd
Saint Clairsville, OH 43950-9119
Phone (740) 695-1210

90 N 4TH St
Martins Ferry, OH 43935-1648
Phone (740) 633-1100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.34 of 100Reported as apm
Quality
79.86
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
95.34 of 100Reported as apm
Quality
79.86
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
West Virginia University Medical Corporation CurrentSince Jul 1, 2021 Accepting new patients
West Virginia University Medical Corporation CurrentSince Jul 1, 2021 Accepting new patients
Reynolds Memorial Hospital, Inc Single Specialty CurrentSince Apr 1, 2023 Accepting new patients

Locations

90 N 4th St
Martins Ferry, OH 43935
Phone (304) 234-8425

107 Plaza Dr
Ste D
Saint Clairsville, OH 43950
Phone (304) 598-6217

800 Wheeling Ave
Glen Dale, WV 26038
Phone (304) 221-4520

1 Medical Center Dr
Morgantown, WV 26506
Phone (304) 293-4500

40 Medical Park
Ste 508
Wheeling, WV 26003
Phone (304) 243-8916

Organizations & group practices 5

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 5

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": "1566259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728345600000",
    "number": "1548817943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 MEDICAL PARK ROAD SUITE 508",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "26003",
            "telephone_number": "304-243-8916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 MEDICAL PARK ROAD SUITE 508",
            "city": "WHEELING",
            "state": "WV",
            "postal_code": "260036861",
            "telephone_number": "304-243-8916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "JESSICA",
        "middle_name": "ANNE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-20",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "WV",
            "license": "2489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheeling, WV

Sources for this page

Verify at the official NPI Registry.