Individual provider Active NPI

Juan Carlos Mejia

  • Physician Assistant
  • Longmeadow, MA
National Provider Identifier
1619600913
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
588 Longmeadow St
Longmeadow, MA 01106-2212
Phone
(413) 565-1000
NPI assigned
Jul 5, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 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

588 Longmeadow St
Longmeadow, MA 01106-2212

Mailing address

588 Longmeadow St
Longmeadow, MA 01106-2212
Phone (413) 565-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, MA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240709000970 CT Practitioner - Physician Assistant 7911442595 Reassigns benefits to 2 organizations
I20250904003514 MA Practitioner - Physician Assistant 7911442595 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Urgent Care Medical Center LLCGroup PAC ID 0840570628, 52 clinicians
Charter Oak Health Center, IncGroup PAC ID 3870401078, shared by 3 NPIs, 37 clinicians

Practice addresses (Care Compare)

105 W Rd
Ellington, CT 06029-5700
Phone (860) 454-0678

1505 Memorial Dr
Chicopee, MA 01020-3900
Phone (413) 366-9977

21 Grand St
Hartford, CT 06106-1541
Phone (860) 550-7500

2909 Berlin Tpke
Newington, CT 06111-4115
Phone (860) 454-0678

311 E Main St
Westfield, MA 01085-3307
Phone (413) 516-2355

430 Cooley St
Springfield, MA 01128-1180
Phone (413) 295-4144

45 S Main St
Unionville, CT 06085-1278
Phone (860) 470-7710

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Charter Oak Health Center, Inc. CurrentSince May 20, 2024 Accepting new patients
Charter Oak Health Center, Inc. CurrentSince May 20, 2024 Accepting new patients

Locations

21 Grand St
Hartford, CT 06106

Organizations & group practices 3

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": "1656979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1619600913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "588 LONGMEADOW ST",
            "city": "LONGMEADOW",
            "state": "MA",
            "postal_code": "011062212",
            "telephone_number": "413-565-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "588 LONGMEADOW ST",
            "city": "LONGMEADOW",
            "state": "MA",
            "postal_code": "011062212",
            "telephone_number": "413-565-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEJIA",
        "first_name": "JUAN",
        "middle_name": "CARLOS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-05",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmeadow, MA

Sources for this page

Verify at the official NPI Registry.