Jennifer Christine Modesto, B.S., PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601004881 Issued in MI

Practice address

7960 N Wickham Rd Ste 103
Melbourne, FL 32940-8096

Phone

(321) 428-4737

Fax

(321) 241-6457

NPI assigned

Sep 4, 2006

Last updated

Dec 17, 2020By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Physician Assistant

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

David V Spurlin, M.D., P.L.L.C.Group PAC ID 2961405071, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science, Physician Assistant

State licenses

Practice roles

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.

• David V Spurlin, M.D., P.L.L.C.

  dba Pinnacle Dermatology

  • Dermatology Physician
  • Birmingham, MI
  • NPI 1578571303
  Medicare reassignment Care Compare group
• TLK Dermatology PLLC

  • Dermatology Physician
  • Asheboro, NC
  • NPI 1780453464

  Physician Assistant

  NPD (past)

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

• William Beaumont Hospital

  dba Beaumont Hospital, Troy

  • General Acute Care Hospital
  • Troy, MI
  • NPI 1306825997
  Care Compare affiliation
• William Beaumont Hospital

  dba Beaumont Hospital, Royal Oak

  • General Acute Care Hospital
  • Royal Oak, MI
  • NPI 1689653305
  Care Compare affiliation
• William Beaumont Hospital

  dba Beaumont Hospital, Grosse Pointe

  • General Acute Care Hospital
  • Grosse Pointe, MI
  • NPI 1932396017
  Care Compare affiliation

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

{
    "created_epoch": "1157328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608163200000",
    "number": "1750483244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7960 N WICKHAM RD STE 103",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329408096",
            "telephone_number": "321-428-4737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7960 N WICKHAM RD STE 103",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329408096",
            "telephone_number": "321-428-4737",
            "fax_number": "321-241-6457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODESTO",
        "first_name": "JENNIFER",
        "middle_name": "CHRISTINE",
        "name_prefix": "Ms.",
        "credential": "B.S., PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-04",
        "last_updated": "2020-12-17",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004881",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7463850",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00349237",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mobile Physicians Group Inc
• Mobile Ultrasound Imaging, LLC
• Mobility Scooter Center Inc (Mobility Medical Equipment)
• Ronda Lee Mobley, APRN- FNP-C
• Catherine Gabrielle Moceri
• Brinda G Modh
• Heather Dawn Moening, COTA
• Evelyn Denise Moffett, CRNA
• Geneath Moffett
• Emly Moffre

• Physician Assistant in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2020; 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.

Verify at the official NPI Registry.