Individual provider Active NPI

Jackson Hitzemann

  • Physician Assistant
  • Overland Park, KS
National Provider Identifier
1790547784
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
15-03095 Issued in KS
Practice address
15101 Glenwood Ave
Overland Park, KS 66223-3154
Phone
(913) 681-8866
NPI assigned
Jan 25, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2025

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 15-03095 KS Primary

Addresses

Primary practice location

15101 Glenwood Ave
Overland Park, KS 66223-3154

Mailing address

15101 Glenwood Ave
Overland Park, KS 66223-3154

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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

Enrollment IDStateProvider typePAC IDDetails
I20250919004327 KS Practitioner - Physician Assistant 1557865615 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Missouri, Kansas City, School of Medicine, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Overland Park Surgical Specialties LLCGroup PAC ID 9234318502, 86 clinicians

Practice addresses (Care Compare)

10500 Quivira Rd
Overland Park, KS 66215-2306
Phone (913) 541-5000

15101 Glenwood Ave
Stanley, KS 66223-3154
Phone (913) 681-8866

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15-03095KSMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
College Park Family Care Center PA Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jackson.hitzemann@hca2.eclinicaldirectplus.com

Organizations & group practices 2

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": "1706140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758240000000",
    "number": "1790547784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15101 GLENWOOD AVE",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662233154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15101 GLENWOOD AVE",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662233154",
            "telephone_number": "913-681-8866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HITZEMANN",
        "first_name": "JACKSON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-25",
        "last_updated": "2025-09-19",
        "certification_date": "2025-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-03095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

Verify at the official NPI Registry.