NPIMap

Individual provider Active NPI

Jessica M Acosta, PA-C

  • Surgical Physician Assistant
  • Oklahoma City, OK
National Provider Identifier
1578884458
Registry record updated Apr 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
2934 Issued in OK
Practice address
608 NW 9TH St Ste 5010
Oklahoma City, OK 73102-1058
Phone
(405) 979-7875
Fax
(405) 979-7880
NPI assigned
Jun 15, 2010
Last updated
Apr 13, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Surgical Physician Assistant 363AS0400X 2934 OK Primary

Addresses

Primary practice location

608 NW 9TH St Ste 5010
Oklahoma City, OK 73102-1058

Mailing address

3300 NW Expressway
Oklahoma City, OK 73112-4418
Phone (405) 949-3011

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181002003282 OK Practitioner - Physician Assistant 5193914604 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integris Ambulatory Care CorporationGroup PAC ID 2365408465, 687 clinicians

Practice addresses (Care Compare)

3400 NW Expressway
Suite 500
Oklahoma City, OK 73112-4492
Phone (405) 945-4589

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2934OKMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Integris Ambulatory Care C Orporation Past Accepting new patients

Organizations & group practices 3

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 4

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": "1276560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1578884458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 NW EXPRESSWAY",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731124418",
            "telephone_number": "405-949-3011",
            "fax_number": "405-979-7880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 NW 9TH ST STE 5010",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731021058",
            "telephone_number": "405-979-7875",
            "fax_number": "405-979-7880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ACOSTA",
        "first_name": "JESSICA",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-15",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OK",
            "license": "2934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.