NPIMap

Individual provider Active NPI

Jenna Ann Piccolomini, P.A.

  • Physician Assistant
  • Smithfield, PA
National Provider Identifier
1760717144
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA054075 Issued in PA
Practice address
100 Ridgeview Dr Unit 3
Smithfield, PA 15478
Phone
(724) 569-8100
Fax
(724) 569-8368
NPI assigned
Oct 2, 2009
Last updated
Sep 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA054075 PA Primary

Addresses

Primary practice location

100 Ridgeview Dr Unit 3
Smithfield, PA 15478

Mailing address

100 Ridgeview Dr Unit 3
Smithfield, PA 15478-1650
Phone (724) 569-8100

Other identifiers 1

IdentifierTypeStateIssuer
1007288440031OtherPAPROMISE GROUP #

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jpiccolomini@MMI-PA.direct.office.nextgen.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110804000534 PA Practitioner - Physician Assistant 5991974123 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Montgomery Medical IncGroup PAC ID 1355588542, 11 clinicians

Practice addresses (Care Compare)

105 Laurel View Dr
Smithfield, PA 15478-8908
Phone 7245698100206

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA054075PAMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: jenna.piccolomini.1@27404.direct.athenahealth.com
  • Direct secure messaging: jpiccolomini@mmi-pa.direct.office.nextgen.com

Organizations & group practices 1

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 6

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": "1254441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1760717144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 RIDGEVIEW DR UNIT 3",
            "city": "SMITHFIELD",
            "state": "PA",
            "postal_code": "154781650",
            "telephone_number": "724-569-8100",
            "fax_number": "724-569-8368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 RIDGEVIEW DR UNIT 3",
            "city": "SMITHFIELD",
            "state": "PA",
            "postal_code": "15478",
            "telephone_number": "724-569-8100",
            "fax_number": "724-569-8368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICCOLOMINI",
        "first_name": "JENNA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-02",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA054075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROMISE GROUP #",
            "identifier": "1007288440031",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpiccolomini@MMI-PA.direct.office.nextgen.com",
            "affiliation": "N",
            "endpointDescription": "current practice direct email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "100 RIDGEVIEW DR",
            "address_2": "UNIT 3",
            "city": "SMITHFIELD",
            "state": "PA",
            "country_code": "US",
            "postal_code": "154781650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Smithfield, PA

Sources for this page

Verify at the official NPI Registry.