Jared Allen Pendergrass, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2020009814 Issued in MO

Practice address

500 Porter Ave
Aurora, MO 65605-2365

Phone

(417) 678-7888

NPI assigned

Oct 12, 2020

Last updated

Oct 27, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Mercy Hospital Aurora

  • Critical Access Hospital
  • Aurora, MO
  • NPI 1467543090
  Medicare reassignment NPD
• Mercy Hospital Cassville

  • Critical Access Hospital
  • Cassville, MO
  • NPI 1285676932
  Medicare reassignment NPD

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

{
    "created_epoch": "1602460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1780282863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 PORTER AVE",
            "city": "AURORA",
            "state": "MO",
            "postal_code": "656052365",
            "telephone_number": "417-678-7888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 PORTER AVE",
            "city": "AURORA",
            "state": "MO",
            "postal_code": "656052365",
            "telephone_number": "417-678-7888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDERGRASS",
        "first_name": "JARED",
        "middle_name": "ALLEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-12",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2020009814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ozark Tri-County Health Care Consortium (ACCESS Family Care)
• Laura Papp, SPEECH
• Lisa Parker
• Allison Patton
• Paul B Andelin MD PC
• Bryan Porter, PHARMD
• Pratt Eye Care LLC (Pratt 20/20 Eyecare)
• Larry F Pratt, O.D.
• Preferred Family Healthcare
• Preferred Family Healthcare

• Physician Assistant in Aurora, MO
• Providers in Aurora, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.