Individual provider Active NPI

Jessica Ann Ircink, PA-C

  • Physician Assistant
  • Fishersville, VA
National Provider Identifier
1609618461
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
100 Baldwin Blvd
Fishersville, VA 22939-2375
Phone
(509) 496-1177
NPI assigned
Jun 11, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

100 Baldwin Blvd
Fishersville, VA 22939-2375

Mailing address

100 Baldwin Blvd
Fishersville, VA 22939-2375
Phone (509) 496-1177

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20260513000247 NY Practitioner - Physician Assistant 2163991753 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

820 US Route 9 Northway Plaza
Suite 4F
Queensbury, NY 12804-1766

PO Box
Suite 25213
Belfast, ME 04915-2003

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

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.

NPI Registry JSON

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

{
    "created_epoch": "1718064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1609618461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BALDWIN BLVD",
            "city": "FISHERSVILLE",
            "state": "VA",
            "postal_code": "229392375",
            "telephone_number": "509-496-1177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BALDWIN BLVD",
            "city": "FISHERSVILLE",
            "state": "VA",
            "postal_code": "229392375",
            "telephone_number": "509-496-1177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IRCINK",
        "first_name": "JESSICA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-11",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fishersville, VA

Sources for this page

Verify at the official NPI Registry.