Active NPI
Jill Davis, PA
- Physician Assistant
- Durham, NC
National Provider Identifier
1619033446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0010-01654
- Practice address
- Dumc 3158
Durham, NC 27710-0001 - Phone
- (919) 684-5118
- Fax
- (919) 668-1559
- NPI assigned
- Dec 28, 2006
- Last updated
- May 5, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085-002554 | IL | |
| Physician Assistant | 363A00000X | 0010-01654 | NC | Primary |
Addresses
Primary practice location
Dumc 3158
Durham, NC 27710-0001
Mailing address
Dumc 3158
Durham, NC 27710-0001
Phone (919) 684-5118
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3932056 | Other | IL | BCBS |
| 7210895 | Other | IL | AETNA |
| 733354 | Other | IL | HEALTHLINK |
| 109260 | Other | IL | HAMP INS. # |
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085-002554 | IL | MD | Physician Assistant |
| 0010-01654 | NC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241481600000",
"number": "1619033446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "DUMC 3158",
"city": "DURHAM",
"state": "NC",
"postal_code": "277100001",
"telephone_number": "919-684-5118",
"fax_number": "919-668-1559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "DUMC 3158",
"city": "DURHAM",
"state": "NC",
"postal_code": "277100001",
"telephone_number": "919-684-5118",
"fax_number": "919-668-1559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JILL",
"name_prefix": "Ms.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-28",
"last_updated": "2009-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085-002554",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "0010-01654",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "3932056",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7210895",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "733354",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HAMP INS. #",
"identifier": "109260",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.