Jessica Ella Collins, PA-C
Individual provider Active NPI Physician Assistant · Copperhill, TN
NPI 1760433288 · NPPES record last updated Apr 3, 2023
Key facts
- NPI
- 1760433288
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA0000003154 (TN)
- Practice address
- 144 Medical Center Dr
Ste B
Copperhill, TN 37317-5005 - Phone
- (423) 496-9214
- Fax
- (423) 496-7809
- NPI assigned
- May 12, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in GA, NC, TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050323000305 | GA | Practitioner - Physician Assistant | 5991751984 | Reassigns benefits to 2 organizations |
| I20160325000724 | NC | Practitioner - Physician Assistant | 5991751984 | Reassigns benefits to 2 organizations |
| I20170104000301 | TN | Practitioner - Physician Assistant | 5991751984 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004460 | GA | MD | Physical Therapist |
| PA0000003154 | TN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riverstonemd PC | Physician Assistant | Current | Accepting new patients |
Locations
101 Riverstone Vis
Ste 205
Blue Ridge, GA 30513
Phone (706) 632-4400
101 Riverstone Vis
Ste 111
Blue Ridge, GA 30513
Phone (706) 258-4400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 004460 | GA | |
| Physician Assistant | 363A00000X | PA0000003154 | TN | Yes |
Addresses
Primary practice location
144 Medical Center Dr
Ste B
Copperhill, TN 37317-5005
Mailing address
144 Medical Center Dr
Ste B
Copperhill, TN 37317-5005
Phone (423) 496-9214
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 193898892A | Medicaid | GA | |
| Q026000 | Medicaid | TN |
Other providers in Copperhill, TN
- Richard Adler
- Ameripro EMS of Tennessee, LLC
- Tiffany Boring
- C Dennis Muse
- Caremed EMS of Tennessee LLC
- David Wayne Cook
- Copper Basin Community Hospital
- Copper Basin Community Hospital Inc
- Copper Basin Community Hospital Inc
- Copper Basin Community Hospital Inc
All providers in Copperhill, TN · Physician Assistant in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.