Active NPI
David Jenkins, PA-C
- Physician Assistant
- West Lafayette, IN
National Provider Identifier
1619710399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 1400 Mitch Daniels Blvd
Ste C and D
West Lafayette, IN 47906-3438 - Phone
- (765) 494-0111
- NPI assigned
- Jun 18, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
1400 Mitch Daniels Blvd
Ste C and D
West Lafayette, IN 47906-3438
Mailing address
501 Lapin LN
West Lafayette, IN 47906-9487
Phone (708) 870-8099
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250721002898 | IL | Practitioner - Physician Assistant | 9335655901 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718668800000",
"number": "1619710399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 LAPIN LN",
"city": "WEST LAFAYETTE",
"state": "IN",
"postal_code": "479069487",
"telephone_number": "708-870-8099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 MITCH DANIELS BLVD",
"address_2": "STE C AND D",
"city": "WEST LAFAYETTE",
"state": "IN",
"postal_code": "479063438",
"telephone_number": "765-494-0111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "DAVID",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-06-18",
"last_updated": "2024-06-18",
"certification_date": "2024-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.