Provider Demographics
NPI:1649326349
Name:HILL, JEREMY ADAM (PA)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:ADAM
Last Name:HILL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3768
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-3768
Mailing Address - Country:US
Mailing Address - Phone:209-384-5766
Mailing Address - Fax:209-383-4230
Practice Address - Street 1:374 WEST OLIVE AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3137
Practice Address - Country:US
Practice Address - Phone:209-384-5766
Practice Address - Fax:209-383-4230
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17082363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA17082Medicaid
CA0PA170821Medicare PIN
CA0PA170820Medicare PIN