NPIMap

Individual provider Active NPI

Jessica F. Doerrler, PA-C

  • Medical Physician Assistant
  • Winston Salem, NC
National Provider Identifier
1750637815
Registry record updated Sep 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
500 Shepherd St
Suite 300
Winston Salem, NC 27103
Phone
(336) 713-7306
Fax
(336) 713-7322
NPI assigned
Jul 26, 2012
Last updated
Sep 9, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA9106657 FL
Medical Physician Assistant 363AM0700X Primary

Addresses

Primary practice location

500 Shepherd St
Suite 300
Winston Salem, NC 27103

Mailing address

500 Shepherd St
Suite 300
Winston Salem, NC 27103
Phone (336) 713-7306

Other identifiers 1

IdentifierTypeStateIssuer
007385100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120928000609 FL Practitioner - Physician Assistant 7911156344 Reassigns benefits to 1 organization
I20180524000836 NC Practitioner - Physician Assistant 7911156344 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Florida College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

500 Shepherd St
Winston Salem, NC 27103-1633
Phone (336) 716-2734

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9106657FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Apr 19, 2018 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Jul 25, 2016 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Jul 25, 2016 Accepting new patients
Simedhealth LLC Past Accepting new patients

Locations

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

1600 SW Archer Rd
#100371
Gainesville, FL 32610
Phone (352) 265-8335

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

500 Shepherd St
Ste 300
Winston Salem, NC 27103
Phone (336) 713-7777

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1343260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567987200000",
    "number": "1750637815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 SHEPHERD ST",
            "address_2": "SUITE 300",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-713-7306",
            "fax_number": "336-713-7322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SHEPHERD ST",
            "address_2": "SUITE 300",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-713-7306",
            "fax_number": "336-713-7322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOERRLER",
        "first_name": "JESSICA",
        "middle_name": "F.",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-26",
        "last_updated": "2019-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9106657",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007385100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.