Jesse Illich, PAS1

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-13685 Issued in NC

Practice address

240 Highway 105 Ext Ste 100
Boone, NC 28607-4291

Phone

(828) 264-7311

Fax

(828) 264-7907

NPI assigned

Jan 15, 2022

Last updated

Dec 14, 2023By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

T4 Medical PLLCGroup PAC ID 0244769156, 30 clinicians

High Country Community HealthGroup PAC ID 8628225190, shared by 10 NPIs, 34 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Watauga Medical Center Hospital, Boone, NC, CCN 340051
• Ashe Memorial Hospital Hospital, Jefferson, NC, CCN 341325

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JJJEBD

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.

• T4 Medical PLLC

  • Family Medicine Physician
  • Boone, NC
  • NPI 1699546861
  Medicare reassignment Care Compare group
• High Country Community Health

  • Federally Qualified Health Center (FQHC)
  • Newland, NC
  • NPI 1083979082
  Medicare reassignment NPD
• High Country Community Health

  dba High Country Community Health Primedical

  • Federally Qualified Health Center (FQHC)
  • Boone, NC
  • NPI 1518620665
  Medicare reassignment NPD
• High Country Community Health

  • Federally Qualified Health Center (FQHC)
  • Mount Airy, NC
  • NPI 1629942115
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ashe Memorial Hospital Inc

  • Critical Access Hospital
  • Jefferson, NC
  • NPI 1376671370
  Care Compare affiliation
• Watauga Medical Center Inc

  dba Watauga Medical Center

  • General Acute Care Hospital
  • Boone, NC
  • NPI 1205859766
  Care Compare affiliation

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

{
    "created_epoch": "1642204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1821749383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1490",
            "city": "BOONE",
            "state": "NC",
            "postal_code": "286071490",
            "telephone_number": "828-262-3886",
            "fax_number": "828-265-4816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 HIGHWAY 105 EXT STE 100",
            "city": "BOONE",
            "state": "NC",
            "postal_code": "286074291",
            "telephone_number": "828-264-7311",
            "fax_number": "828-264-7907"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 S University Dr",
            "address_purpose": "LOCATION",
            "city": "Davie",
            "state": "FL",
            "postal_code": "333282018",
            "country_code": "US",
            "telephone_number": "954-262-1250",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "935 State Farm Rd",
            "address_purpose": "LOCATION",
            "city": "Boone",
            "state": "NC",
            "postal_code": "286074948",
            "country_code": "US",
            "telephone_number": "828-262-3886",
            "fax_number": "828-265-4816",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "301 E Meeting St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Morganton",
            "state": "NC",
            "postal_code": "286553594",
            "country_code": "US",
            "telephone_number": "828-608-0800",
            "fax_number": "828-528-5800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1925 N Bridge St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Elkin",
            "state": "NC",
            "postal_code": "286212105",
            "country_code": "US",
            "telephone_number": "336-835-7337",
            "fax_number": "336-835-7301",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "448 Cranberry St",
            "address_purpose": "LOCATION",
            "city": "Newland",
            "state": "NC",
            "postal_code": "286578800",
            "country_code": "US",
            "telephone_number": "828-737-0221",
            "fax_number": "828-737-0321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ILLICH",
        "first_name": "JESSE",
        "credential": "PAS1",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-15",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-13685",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Callie Whitney Hutchens, LCMHC-A
• Emily Kathryn Hutelmyer, SLP
• Mariah Hydzik, DO
• Lisa Bernard Hypes, PT
• Icenhour Counseling
• Inhabit Counseling & Consultation, PLLC
• Innate Chiropractic PLLC (EPIC Family Chiropractic)
• Halcyon L Inniss, DDS
• Callie Isaacs, RN
• Johnna Michelle Isaacs, B.S.

• Physician Assistant in Boone, NC
• Providers in Boone, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.