Active NPI
Jennifer H Fortenberry, PA
- Medical Physician Assistant
- Harrisburg, PA
National Provider Identifier
1609012368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- MA056018
- Practice address
- 2401 Park Dr Ste 101
Harrisburg, PA 17110-9303 - Phone
- (717) 686-9842
- NPI assigned
- Dec 31, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 2002014284 | MO | |
| Orthopaedic Foot and Ankle Surgery Physician | 207XX0004X | 2002014284 | MO | |
| Medical Physician Assistant | 363AM0700X | MA056018 | PA | Primary |
Addresses
Primary practice location
2401 Park Dr Ste 101
Harrisburg, PA 17110-9303
Mailing address
3421 Concord Rd
York, PA 17402-9001
Phone (717) 851-1405
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1620177 | Other | PA | GATEWAY MEDICARE ASSURED |
| 2888522 | Other | PA | HIGHMARK BLUE SHIELD-FREEDOM BLUE |
Other names 1
- Jennifer Hanshaw McGovern
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA056018 | PA | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Interoperability endpoints
- jfortenberry@landmarkhealth-direct.org
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1230681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571961600000",
"number": "1609012368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3421 CONCORD RD",
"city": "YORK",
"state": "PA",
"postal_code": "174029001",
"telephone_number": "717-851-1405",
"fax_number": "717-851-6969"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2401 PARK DR STE 101",
"city": "HARRISBURG",
"state": "PA",
"postal_code": "171109303",
"telephone_number": "717-686-9842"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTENBERRY",
"first_name": "JENNIFER",
"middle_name": "H",
"name_prefix": "Ms.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-12-31",
"last_updated": "2019-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "MO",
"license": "2002014284",
"primary": false
},
{
"code": "207XX0004X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
"state": "MO",
"license": "2002014284",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "PA",
"license": "MA056018",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GATEWAY MEDICARE ASSURED",
"identifier": "1620177",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK BLUE SHIELD-FREEDOM BLUE",
"identifier": "2888522",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "MCGOVERN",
"middle_name": "HANSHAW",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Harrisburg, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.