Jenna Ambrose, PA-C
Individual provider Active NPI Physician Assistant · Indianapolis, IN
NPI 1881364487 · NPPES record last updated Nov 4, 2021
Key facts
- NPI
- 1881364487
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 10003449A (IN)
- Practice address
- 1050 Wishard Blvd
Indianapolis, IN 46202-2872 - Phone
- (317) 278-9575
- NPI assigned
- Sep 15, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- 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 |
|---|---|---|---|---|
| I20211122001664 | IN | Practitioner - Physician Assistant | 7214326727 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Interoperability endpoints
- jenna.ambrose@478125320568836.direct.elationemr.com
- jenna.ambrose@krogerhealth.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | |||
| Physician Assistant | 363A00000X | 10003449A | IN | Yes |
Addresses
Primary practice location
1050 Wishard Blvd
Indianapolis, IN 46202-2872
Mailing address
2620 Elm Hill Pike
Nashville, TN 37214-3108
Phone (901) 574-0686
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jenmfish@iu.edu |
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- Amedisys Hospice, L.L.C.
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All providers in Indianapolis, IN · Physician Assistant in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2021. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.