Individual provider Active NPI

Jessica M. Davidson, M.D.

  • Neonatal-Perinatal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1861620064
Registry record updated Oct 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
ME454991 Issued in PA
Practice address
111 S 11TH St
Philadelphia, PA 19107-4824
Phone
(215) 595-5652
Fax
(215) 923-9519
NPI assigned
Jun 25, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 241647 MA
Neonatal-Perinatal Medicine Physician 2080N0001X ME454991 PA Primary

Addresses

Primary practice location

111 S 11TH St
Philadelphia, PA 19107-4824

Mailing address

PO Box 191
Provider Enrollment Department
Rockland, DE 19732-0191
Phone (904) 697-5062

Other names 1

  • Jessica Crocker Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jdavidson272711@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171120003141 UT Practitioner - Pediatric Medicine 9032419783 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
241647MAMDPediatrics Physician
ME454991PAMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc CurrentSince Jan 1, 2018 Accepting new patients
University of Utah Pediatric Acuity Care CurrentSince Dec 1, 2017 Accepting new patients
Ihc Health Services, Inc. CurrentSince Jan 1, 2018 Accepting new patients
University of Utah Pediatric Acuity Care Pediatrics Current Accepting new patients
Ihc Health Services Inc Family Medicine Current Accepting new patients
University of Utah Pediatric Acuity Care CurrentSince Dec 1, 2017 Accepting new patients
University of Utah Pediatric Acuity Care Neonatal-Perinatal Medicine Past Accepting new patients
SCHC Pediatric Associates, LLC Pediatrics Past Accepting new patients

Locations

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

2250 N Miller Campus Dr
Lehi, UT 84048
Phone (385) 531-1000

127 S 500 E
Ste 200
Salt Lake City, UT 84102

127 S 500 E
Ste 400B
Salt Lake City, UT 84102
Phone (801) 587-6478

5121 S Cottonwood St
Salt Lake Cty, UT 84107
Phone (801) 408-8998

400 C St
Salt Lake Cty, UT 84143
Phone (435) 688-4080

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

100 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 587-7109

Organizations & group practices 8

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": "1245888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634601600000",
    "number": "1861620064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191",
            "address_2": "PROVIDER ENROLLMENT DEPARTMENT",
            "city": "ROCKLAND",
            "state": "DE",
            "postal_code": "197320191",
            "telephone_number": "904-697-5062",
            "fax_number": "302-651-4945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074824",
            "telephone_number": "215-595-5652",
            "fax_number": "215-923-9519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "JESSICA",
        "middle_name": "M.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-25",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "241647",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "PA",
            "license": "ME454991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jdavidson272711@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "CROCKER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.