Jill C Pease, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10000824A Issued in IN

Practice address

3554 Promenade Pkwy
Suite H
Lafayette, IN 47909-8417

Phone

(765) 471-1100

NPI assigned

Nov 30, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jill C Buckles Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434412800000",
    "number": "1619951126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3554 PROMENADE PKWY",
            "address_2": "SUITE H",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479098417",
            "telephone_number": "765-471-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3554 PROMENADE PKWY",
            "address_2": "SUITE H",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479098417",
            "telephone_number": "765-471-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEASE",
        "first_name": "JILL",
        "middle_name": "C",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-30",
        "last_updated": "2015-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10000824A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000000540149",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILL",
            "last_name": "BUCKLES",
            "middle_name": "C",
            "credential": "PHYSICIAN ASSISTANT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Paul J. Challgren DDS PC
• Miguel Paz, MD
• Laura Faye Peacock, NP
• Alyssa Pearson
• Melissa Mae Pearson, MD
• Dixie J Pederson, PH.D.
• Pediatric Associates of Lafayette, P.C.
• Pediatric Physical Therapy Services Inc
• Pediatric Physical Therapy Services, Inc.
• Kayla Lynne Pellam, BS

• Physician Assistant in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.