| Jesse Illich, PAS1 | |
|
240 Highway 105 Ext Ste 100, Boone, NC 28607-4291 | |
| (828) 264-7311 | |
| (828) 264-7907 |
| Full Name | Jesse Illich |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Experience | 3 Years |
| Location | 240 Highway 105 Ext Ste 100, Boone, North Carolina |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821749383 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 0010-13685 (North Carolina) | Primary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Watauga Medical Center | Boone, NC | Hospital |
| Ashe Memorial Hospital | Jefferson, NC | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| T4 Medical Pllc | 0244769156 | 30 |
| High Country Community Health | 8628225190 | 34 |
| Entity Name | High Country Community Health |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1083979082 PECOS PAC ID: 8628225190 Enrollment ID: O20140314000056 |
| Entity Name | High Country Community Health |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1518620665 PECOS PAC ID: 8628225190 Enrollment ID: O20220228000084 |
| Entity Name | T4 Medical PLLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1699546861 PECOS PAC ID: 0244769156 Enrollment ID: O20250122001838 |
| Mailing Address | Practice Location Address |
|---|---|
| Jesse Illich, PAS1 Po Box 1490, Boone, NC 28607-1490 Ph: (828) 262-3886 | Jesse Illich, PAS1 240 Highway 105 Ext Ste 100, Boone, NC 28607-4291 Ph: (828) 264-7311 |
Mrs. Cassandra Lynn Stull, MPAS, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: Mary S Shook Student Health Services, 614 Howard St Po Office Box 32070, Boone, NC 28608 Phone: 828-262-3100 Fax: 828-262-6262 |
Celeste Halcomb, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 579 Greenway Rd Ste 200, Boone, NC 28607 Phone: 828-262-0100 |
Mrs. Anne Dixon, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 222 Longvue Dr, Boone, NC 28607 Phone: 828-355-9624 Fax: 828-355-9626 |
Sarah Yoder Montgomery, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 400 Shadowline Dr # 100, Boone, NC 28607 Phone: 828-263-8707 |
Mrs. Jennifer Vinez Slagle, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 579 Greenway Rd., Suite 200, Boone, NC 28607 Phone: 828-262-0100 Fax: 828-264-7592 |
Mr. James R Byrd, PA Physician Assistant Medicare: Medicare Enrolled Practice Location: 178 Highway 105 Ext Ste 201, Boone, NC 28607 Phone: 828-262-1800 Fax: 828-262-5777 |
Armando Jorge Guerrero, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 336 Deerfield Rd, Boone, NC 28607 Phone: 828-262-4100 |