Judy Nanesi Arthur Jackson, PA
Individual provider Active NPI Physician Assistant · Springfield, MA
NPI 1619600681 · NPPES record last updated Apr 13, 2024
Key facts
- NPI
- 1619600681
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA9504 (MA)
- Practice address
- 305 Bicentennial Highway
Department of Pediatrics
Springfield, MA 01118 - Phone
- (413) 733-4101
- Fax
- (413) 783-9544
- NPI assigned
- Jul 6, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240315001036 | MA | Practitioner - Physician Assistant | 0648616342 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9504 | MA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riverbend Medical Group, Inc | Current |
Accepting new patients | |
| Mwa,PC | Past | Accepting new patients | |
| Baystate Medical Practices, Inc | Past |
Accepting new patients |
Locations
305 Bicentennial Hwy
Springfield, MA 01118
Phone (413) 733-4101
271 Carew St
Springfield, MA 01104
Phone (413) 748-9000
Interoperability endpoints
- jarthurjackson3102558@direct.trinity-health.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9504 | MA | Yes |
Addresses
Primary practice location
305 Bicentennial Highway
Department of Pediatrics
Springfield, MA 01118
Mailing address
588 Longmeadow St
Longmeadow, MA 01106-2212
Phone (413) 565-1000
Other providers in Springfield, MA
- Sergio A. Arroyo
- Stephanie M. Arroyo
- Elizabeth T Arsenio
- Joebeth Manzanares Arsolon
- Andrew William Artenstein
- Phillicia Arthurton
- David E Artzerounian
- Madeline Arzola
- Walid Asaad
- Frederick Asante-Somuah
All providers in Springfield, MA · Physician Assistant in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.