Individual provider Active NPI

Jill O. Dutra, PA-C

  • Medical Physician Assistant
  • Dover, NH
National Provider Identifier
1679098818
Registry record updated Mar 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1291 Issued in NH
Practice address
770 Central Ave
Dover, NH 03820-3437
Phone
(603) 742-0101
NPI assigned
Aug 9, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363AM0700X 1291 NH Primary

Addresses

Primary practice location

770 Central Ave
Dover, NH 03820-3437

Mailing address

PO Box 412503
Boston, MA 02241-2503
Phone (617) 726-3884

Other identifiers 1

IdentifierTypeStateIssuer
3110787MedicaidNH

Other names 1

  • Jill Oliver Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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

Enrollment IDStateProvider typePAC IDDetails
I20170913001497 NH Practitioner - Physician Assistant 7113290149 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

150 Marketplace Blvd
Unit 9
Rochester, NH 03867-4387
Phone (603) 516-4212

789 Central Ave
Dover, NH 03820-2526

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wentworth Douglass Physician Corporation Single Specialty CurrentSince May 1, 2022 Accepting new patients
Wentworth Douglass Hospital Single Specialty Current Accepting new patients
Westchester Neurological Consultant PC Single Specialty Past Accepting new patients

Locations

8 Century Pines Dr
Ste 2
Barrington, NH 03825
Phone (603) 664-2135

789 Central Ave
Dover, NH 03820
Phone (603) 740-2832

65 Calef Hwy
Ste 200
Lee, NH 03861
Phone (603) 868-3300

67 Corporate Dr
#300
Portsmouth, NH 03801
Phone (603) 516-0092

150 Marketplace Blvd
Unit 9
Rochester, NH 03867
Phone (603) 516-4212

Interoperability endpoints

  • Direct secure messaging: oliver.jill.wdh@direct.partners.masshiway.net
  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1502236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678665600000",
    "number": "1679098818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 412503",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022412503",
            "telephone_number": "617-726-3884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 CENTRAL AVE",
            "city": "DOVER",
            "state": "NH",
            "postal_code": "038203437",
            "telephone_number": "603-742-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUTRA",
        "first_name": "JILL",
        "middle_name": "O.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-09",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "NH",
            "license": "1291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3110787",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILL",
            "last_name": "OLIVER",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dover, NH

Sources for this page

Verify at the official NPI Registry.