JIMMY JR. CONTRERAS – Physician Assistant, NPI 1134819402

JIMMY JR. CONTRERAS is a healthcare provider. based in Fort campbell, Kentucky. specializing in PHYSICIAN ASSISTANT. The NPI Number for JIMMY JR. CONTRERAS is 1134819402

Main info

Male
2 Years Of Experience
Accepts Medicare Assignment
Name
JIMMY JR. CONTRERAS
NPI
1134819402
Phone
Not provided
Address
650 JOEL DR
Enumeration Date
10 May 2023
Last Update Date
10 May 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7312817501
Graduation Year
2024 (2 years ago)
PAC ID
0345764593
Group Practice PAC ID
6800256512
Professional Enrollment ID
I20250409000519
Address ID
TN382372742MA215XXRDXX303
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience21
Completeness75
Years active:3State licenses:0Digital endpointsOther names

1,728 PHYSICIAN ASSISTANT in KY

Provider Addresses for JIMMY JR. CONTRERAS

  • 650 JOEL DR

    FORT CAMPBELL, KY 422235318

    Phone:

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-04-09

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250409000519IPhysician AssistantTNTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 42223)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6800256512View full group profile
NameSpecialtyState
Nurse PractitionerTN
Nurse PractitionerTN
Nurse PractitionerTN

Reviews

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Frequently asked questions

Can I verify JIMMY JR. CONTRERAS with an NPI only?
You can start verification with NPI 1134819402 for JIMMY JR. CONTRERAS, then check state licensing separately.
Is JIMMY JR. CONTRERAS listed as active for patients and plans?
The listing shows JIMMY JR. CONTRERAS as active in the NPI system.
What taxonomy line describes JIMMY JR. CONTRERAS?
For research purposes, treat JIMMY JR. CONTRERAS as Physician Assistant in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for JIMMY JR. CONTRERAS?
JIMMY JR. CONTRERAS's geographic hint is Fort Campbell, Kentucky in our summary view.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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