Active NPI
Jacqueline Ann McIntyre, C.S.A
- Surgical Physician Assistant
- Chesapeake, VA
National Provider Identifier
1932425451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 3399
- Practice address
- 624 Wickwood Dr
Chesapeake, VA 23322-5875 - Phone
- (813) 854-1664
- Fax
- (813) 854-2244
- NPI assigned
- Apr 8, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 3399 | VA | Primary |
Addresses
Primary practice location
624 Wickwood Dr
Chesapeake, VA 23322-5875
Mailing address
624 Wickwood Dr
Chesapeake, VA 23322-5875
Phone (813) 854-1664
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3399 | VA | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeastern Surgical Assistants, Inc | Surgical | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Surgical Physician Assistant
- Chesapeake, VA
- NPI 1013157098
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270684800000",
"number": "1932425451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "624 WICKWOOD DR",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233225875",
"telephone_number": "813-854-1664",
"fax_number": "813-854-2244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "624 WICKWOOD DR",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233225875",
"telephone_number": "813-854-1664",
"fax_number": "813-854-2244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCINTYRE",
"first_name": "JACQUELINE",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "C.S.A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-04-08",
"last_updated": "2010-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "VA",
"license": "3399",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chesapeake, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.