Jillian M Tallarico, PA-C
Individual provider Active NPI Medical Physician Assistant · Stevens, PA
NPI 1861737348 · NPPES record last updated Feb 14, 2020
Key facts
- NPI
- 1861737348
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- MA055910 (PA)
- Practice address
- 63 W Church St
Stevens, PA 17578-9203 - Phone
- (717) 721-8795
- Fax
- (717) 336-8284
- NPI assigned
- Dec 10, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Wellspan Medical Group
Practice addresses (Care Compare)
169 Martin Ave
Ephrata, PA 17522-1724
Phone (717) 733-0311
25 Monument Rd
York, PA 17403-5073
2618 E Market St
Autumn House
York, PA 17403
Phone (717) 845-7214
63 W Church St
Wellspan Bariatric Surgery
Stevens, PA 17578-9203
Phone (717) 721-8795
735 Norman Dr
Lebanon, PA 17042-7559
735 Norman Dr B
Lebanon, PA 17042-7559
735 Norman Drive C
Wellspan Infectious Disease Specialists
Lebanon, PA 17042-7559
Phone (717) 639-2299
914 W Market St
Autumn House West
York, PA 17403
Phone (717) 845-7214
Hospital & facility affiliations
- Wellspan Ephrata Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130110000452 | PA | Practitioner - Physician Assistant | 1355594987 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA055910 | PA | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellspan Medical Group | Current |
Accepting new patients | |
| Wellspan Medical Group | Current |
Accepting new patients | |
| Wellspan Medical Group | Physician Assistant | Past | Accepting new patients |
Locations
735 Norman Dr
Lebanon, PA 17042
Phone (717) 270-7908
63 W Church St
Stevens, PA 17578
Phone (717) 335-3311
3421 Concord Rd
York, PA 17402
Phone (717) 851-2441
25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250
1600 S George St
York, PA 17403
Phone (717) 848-3615
Interoperability endpoints
- jtallarico61801@wellspan.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | MA055910 | PA | Yes |
Addresses
Primary practice location
63 W Church St
Stevens, PA 17578-9203
Mailing address
3421 Concord Rd
York, PA 17402-9001
Phone (717) 721-8795
Other practice location 1
735 Norman Dr
Lebanon, PA 17042-7559
Phone (717) 721-8795
Other providers in Stevens, PA
- Chelsea Leann Sinsheimer
- Stephanie Snader
- Theresa Soley
- Wendy Kay Stafford
- Joann Strausser-Laubenstine
- The Rehab Center
- Thomas L Andersen OD PC
- Allison Weber
- Christine Weiler
- Samantha Wenger
All providers in Stevens, PA · Medical Physician Assistant in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.