Active NPI
Jacklyn Landres, PA-C
- Physician Assistant
- Dunwoody, GA
National Provider Identifier
1619646999
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 10563
- Practice address
- 4546 Barclay Dr
Dunwoody, GA 30338-7147 - Phone
- (770) 457-7994
- NPI assigned
- Sep 9, 2021
- Last updated
- Sep 9, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 | 027125 | NY | |
| Physician Assistant | 363A00000X | 10563 | GA | Primary |
Addresses
Primary practice location
4546 Barclay Dr
Dunwoody, GA 30338-7147
Mailing address
4546 Barclay Dr
Dunwoody, GA 30338-7147
Phone (770) 457-7994
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA, NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
27111 76TH Ave
New Hyde Park, NY 11040-1436
Phone (718) 289-2100
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Psychiatry Physician
- Atlanta, GA
- NPI 1902556632
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631145600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631145600000",
"number": "1619646999",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4546 BARCLAY DR",
"city": "DUNWOODY",
"state": "GA",
"postal_code": "303387147",
"telephone_number": "770-457-7994"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4546 BARCLAY DR",
"city": "DUNWOODY",
"state": "GA",
"postal_code": "303387147",
"telephone_number": "770-457-7994"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANDRES",
"first_name": "JACKLYN",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-09-09",
"last_updated": "2021-09-09",
"certification_date": "2021-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "027125",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "10563",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dunwoody, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.