NPIMap

Individual provider Active NPI

Jessica Fowler Michalak, PA-C

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1588060412
Registry record updated Apr 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-05219 Issued in NC
Practice address
125 Queens Rd Ste 520
Charlotte, NC 28204-3512
Phone
(980) 302-6500
Fax
(980) 302-6505
NPI assigned
Nov 4, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 0010-05219 NC
Nurse Practitioner 363L00000X 0010-05219 NC
Physician Assistant 363A00000X 0010-05219 NC Primary

Addresses

Primary practice location

125 Queens Rd Ste 520
Charlotte, NC 28204-3512

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

125 Queens Rd Ste 540
Charlotte, NC 28204-3512
Phone (980) 302-6560

Other practice location 2

125 Queens Rd Ste 430
Charlotte, NC 28204-3215
Phone (980) 302-6300

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jmichalak446274@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20160330000244 NC Practitioner - Physician Assistant 3476850835 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Presbyterian HospitalGroup PAC ID 1153231907, 412 clinicians

Practice addresses (Care Compare)

10905 Providence Rd W
Suite 150
Charlotte, NC 28277-1538
Phone (980) 302-7120

125 Queens Rd
Charlotte, NC 28204-3215

1700 Matthews Township Pkwy
Matthews, NC 28105-4658
Phone (980) 302-7010

200 Hawthorne LN
Charlotte, NC 28204-2515
Phone (704) 384-9073

Hospital & facility affiliations

  • Novant Health Presbyterian Medical Center Hospital, Charlotte, NC, CCN 340053
  • Novant Health Matthews Medical Center Hospital, Matthews, NC, CCN 340171
  • Novant Health Ballantyne Medical Center Hospital, Charlotte, NC, CCN 340195

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Mar 20, 2025 Accepting new patients
The Presbyterian Hospital CurrentSince Oct 4, 2020 Accepting new patients
The Presbyterian Hospital CurrentSince Oct 4, 2020 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Mar 20, 2025 Accepting new patients
Novant Medical Group, Inc. Past Accepting new patients

Locations

125 Queens Rd
Ste 430
Charlotte, NC 28204
Phone (980) 302-6300

125 Queens Rd
Ste 640
Charlotte, NC 28204
Phone (980) 302-6761

125 Queens Rd
Ste 540
Charlotte, NC 28204
Phone (980) 302-6560

6324 Fairview Rd
Ste 330
Charlotte, NC 28210
Phone (704) 316-1950

335 N Caswell Rd
Charlotte, NC 28204
Phone (704) 384-7390

125 Queens Rd
Ste 520
Charlotte, NC 28204
Phone (980) 302-6500

2104 Randolph Rd
Charlotte, NC 28207
Phone (704) 344-3900

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: jmichalak446274@direct.novanthealth.org

Organizations & group practices 16

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 16

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": "1415059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745366400000",
    "number": "1588060412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 QUEENS RD STE 520",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043512",
            "telephone_number": "980-302-6500",
            "fax_number": "980-302-6505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 Queens Rd Ste 540",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282043512",
            "country_code": "US",
            "telephone_number": "980-302-6560",
            "fax_number": "980-302-6565",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "125 Queens Rd Ste 430",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282043215",
            "country_code": "US",
            "telephone_number": "980-302-6300",
            "fax_number": "980-302-6305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MICHALAK",
        "first_name": "JESSICA",
        "middle_name": "FOWLER",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-04",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NC",
            "license": "0010-05219",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "0010-05219",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-05219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmichalak446274@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "125 Queens Rd Ste 430",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282043215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.