Individual provider Active NPI

Jessica Lynn Vlasek, PA-C

  • Physician Assistant
  • Reno, NV
National Provider Identifier
1770880361
Registry record updated May 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2018 Issued in NV
Practice address
640 W Moana LN
Reno, NV 89509-4903
Phone
(775) 324-0699
NPI assigned
Feb 17, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA2018 NV Primary
Physician Assistant 363A00000X PA21455 CA

Addresses

Primary practice location

640 W Moana LN
Reno, NV 89509-4903

Mailing address

640 W Moana LN
Reno, NV 89509-4903
Phone (775) 324-0699

Other names 1

  • Jessica Lynn Geddes Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NV2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20140121001505 CA Practitioner - Physician Assistant 1456589449 Reassigns benefits to 1 organization
I20181203000950 NV Practitioner - Physician Assistant 1456589449 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA21455CAMDPhysician Assistant
PA2018NVMDPhysician Assistant
21455CAMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain West Derm-Blackhart, PLLC CurrentSince Dec 1, 2018 Accepting new patients
Mountain West Derm - Blackhart PLLC CurrentSince Dec 1, 2018 Accepting new patients
Skin Cancer and Dermatology Institute Current Accepting new patients

Locations

3640 Warren Way
Ste 100
Reno, NV 89509

640 W Moana Ln
Reno, NV 89509
Phone (775) 882-8777

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.

NPI Registry JSON

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

{
    "created_epoch": "1297900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1770880361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 W MOANA LN",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895094903",
            "telephone_number": "775-324-0699",
            "fax_number": "775-323-6814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 W MOANA LN",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895094903",
            "telephone_number": "775-324-0699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VLASEK",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-17",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA2018",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA21455",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "GEDDES",
            "middle_name": "LYNN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Reno, NV

Sources for this page

Verify at the official NPI Registry.