Jessica Rae Parker, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1113 Issued in ID

Practice address

117 E Main St
Suite a 100
Payson, AZ 85541-5293

Phone

(928) 474-1714

Fax

(928) 468-7644

NPI assigned

Nov 7, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Banner Primary Care Physicians Arizona LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1659640902
  Medicare reassignment NPD
• Banner Primary Care Physicians Arizona LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1790306066
  NPD

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

{
    "created_epoch": "1383782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424908800000",
    "number": "1629407945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 E MAIN ST",
            "address_2": "SUITE A 100",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855415293",
            "telephone_number": "928-474-1714",
            "fax_number": "928-468-7644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 E MAIN ST",
            "address_2": "SUITE A 100",
            "city": "PAYSON",
            "state": "AZ",
            "postal_code": "855415293",
            "telephone_number": "928-474-1714",
            "fax_number": "928-468-7644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKER",
        "first_name": "JESSICA",
        "middle_name": "RAE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-07",
        "last_updated": "2015-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1113",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5518",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ordinary Lifestyles, LLC (Ordinary Lifestyles II)
• Ordinary Lifestyles, LLC (Ordinary Lifestyles III)
• Brenda Marie Ortlund, B.S.
• Tracie Osier
• Bruce M Palmer, M.D.
• Patrick Padrnos O.D. P.C.
• Paul Christian Alexander
• Paul T Yoder MD PLLC
• Cynthia Erin Pawlicki
• Payson Apothecary Pharmacy LLC (Payson Apothecary Pharmacy)

• Physician Assistant in Payson, AZ
• Providers in Payson, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2015; 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.

Verify at the official NPI Registry.