Individual provider Active NPI

Jessica Ann Waatti, PA

  • Medical Physician Assistant
  • Newark, DE
National Provider Identifier
1801344601
Registry record updated May 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
4755 Olgletown-Stanton Rd
Newark, DE 19718-9636
Phone
(130) 273-3100
NPI assigned
Sep 21, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X Primary

Addresses

Primary practice location

4755 Olgletown-Stanton Rd
Newark, DE 19718-9636

Mailing address

27 Mary Jane LN
Elkton, MD 21921-3557
Phone (443) 252-1373

Other identifiers 2

IdentifierTypeStateIssuer
500717752MedicaidOR
2079317MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, DE2 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
I20170103001262 OR Practitioner - Physician Assistant 3274814330 Reassigns benefits to 2 organizations
I20220323001839 DE Practitioner - Physician Assistant 3274814330 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christiana Care Health Services IncGroup PAC ID 9739097569, 1,480 clinicians

Practice addresses (Care Compare)

4755 Ogletown Stanton Rd
Newark, DE 19718-2200
Phone (302) 623-0188

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Christiana Care Health Services Inc CurrentSince Mar 11, 2022 Accepting new patients
Access Telecare, PLLC CurrentSince Dec 1, 2019 Accepting new patients
Christiana Care Health Services Inc CurrentSince Mar 11, 2022 Accepting new patients

Locations

4755 Ogletown Stanton Rd
Ste 5A43
Newark, DE 19718
Phone (302) 623-0188

10300 NE Hancock St
Portland, OR 97220
Phone (503) 257-5500

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.

Hospital & facility affiliations 1

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": "1474416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683504000000",
    "number": "1801344601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 MARY JANE LN",
            "city": "ELKTON",
            "state": "MD",
            "postal_code": "219213557",
            "telephone_number": "443-252-1373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 OLGLETOWN-STANTON RD",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197189636",
            "telephone_number": "130-273-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAATTI",
        "first_name": "JESSICA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-21",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500717752",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2079317",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

Verify at the official NPI Registry.