Individual provider Active NPI

Jessica N Smith, PA-C

  • Physician Assistant
  • Lebanon, PA
National Provider Identifier
1598135626
Registry record updated Oct 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
OA003621 Issued in PA
Practice address
252 S 4TH St
Lebanon, PA 17042-6111
Phone
(717) 270-7740
NPI assigned
Oct 1, 2015
Last updated
Oct 1, 2015By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2015

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 OA003621 PA Primary
Physician Assistant 363A00000X MA057813 PA

Addresses

Primary practice location

252 S 4TH St
Lebanon, PA 17042-6111

Mailing address

PO Box 1281
4TH and Walnut St
Lebanon, PA 17042-6937
Phone (717) 269-9405

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
I20151117000142 PA Practitioner - Physician Assistant 1052621372 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA057813PAMDPhysician Assistant
OA003621PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspan Medical Group CurrentSince Aug 24, 2020 Accepting new patients
Emergency Care Services of Pennsylvania, P.C. Physician Assistant CurrentSince Oct 1, 2017 Accepting new patients
Wellspan Medical Group CurrentSince Aug 24, 2020 Accepting new patients
Wellspan Medical Group PastSince Apr 1, 2020 Accepting new patients

Locations

9 Nathan Ln
Annville, PA 17003
Phone (717) 639-3350

252 S 4th St
Lebanon, PA 17042
Phone (717) 270-7500

1600 S George St
York, PA 17403
Phone (717) 848-3615

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

Interoperability endpoints

  • Direct secure messaging: jsmith73520@wellspan.direct-ci.com

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1443657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443657600000",
    "number": "1598135626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1281",
            "address_2": "4TH AND WALNUT ST",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170426937",
            "telephone_number": "717-269-9405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "252 S 4TH ST",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170426111",
            "telephone_number": "717-270-7740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JESSICA",
        "middle_name": "N",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-01",
        "last_updated": "2015-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "OA003621",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA057813",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, PA

Sources for this page

Verify at the official NPI Registry.