Individual provider Active NPI

Jessica Blair Dijulio, MA, MMS, PA-C

  • Dermatology Physician
  • Philadelphia, PA
National Provider Identifier
1578046603
Registry record updated Jul 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MA060109 Issued in PA
Practice address
833 Chestnut St
Philadelphia, PA 19107-4414
Phone
(484) 951-4055
NPI assigned
Sep 14, 2018
Last updated
Jul 14, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X MA060109 PA Primary

Addresses

Primary practice location

833 Chestnut St
Philadelphia, PA 19107-4414

Mailing address

833 Chestnut St Ste 740
Philadelphia, PA 19107-4409
Phone (215) 955-6680

Other identifiers 2

IdentifierTypeStateIssuer
OA004607OtherPASTATE BOARD OF OSTEOPATHIC MEDICINE LICENSE
MA060109OtherPASTATE BOARD OF MEDICINE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20190329001855 PA Practitioner - Physician Assistant 0547500530 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pennsylvania Dermatology Partners IncGroup PAC ID 3274794268, 75 clinicians

Practice addresses (Care Compare)

3760 Brookside Rd
Macungie, PA 18062-1741
Phone (610) 770-2708

6 Hearthstone CT
Suite 200 203
Reading, PA 19606-3065
Phone (610) 288-2908

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts, Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA060109PAMDDermatology Physician

Interoperability endpoints

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

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.

Hospital & facility affiliations 6

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": "1536883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594684800000",
    "number": "1578046603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 CHESTNUT ST STE 740",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074409",
            "telephone_number": "215-955-6680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 CHESTNUT ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074414",
            "telephone_number": "484-951-4055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIJULIO",
        "first_name": "JESSICA",
        "middle_name": "BLAIR",
        "credential": "MA, MMS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-14",
        "last_updated": "2020-07-14",
        "certification_date": "2020-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MA060109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD OF OSTEOPATHIC MEDICINE LICENSE",
            "identifier": "OA004607",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD OF MEDICINE LICENSE",
            "identifier": "MA060109",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.