Jennifer Anne Shattuck, N.P.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

334772 Issued in NY

Practice address

260 Riverside Dr
Johnson City, NY 13790-2745

Phone

(607) 798-7811

NPI assigned

Jul 26, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Our Lady of Lourdes Memorial Hospital IncGroup PAC ID 1254237779, 249 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Our Lady of Lourdes Memorial Hospital, Inc Hospital, Binghamton, NY, CCN 330011

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jshattuck196731@direct-guthrie.org

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.

• Our Lady of Lourdes Memorial Hospital Inc.

  • General Acute Care Hospital
  • Binghamton, NY
  • NPI 1629087580
  Medicare reassignment Care Compare group
• Our Lady of Lourdes Memorial Hospital, Inc.

  • Family Medicine Physician
  • Binghamton, NY
  • NPI 1063557189
  NPD
• Twin Tier Pathology Associates, PC

  • Clinical Pathology/Laboratory Medicine Physician
  • Binghamton, NY
  • NPI 1770577470
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Our Lady of Lourdes Memorial Hospital Inc.

  • General Acute Care Hospital
  • Binghamton, NY
  • NPI 1629087580
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616112000000",
    "number": "1023032729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 RIVERSIDE DR",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902745",
            "telephone_number": "607-798-7811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 RIVERSIDE DR",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902745",
            "telephone_number": "607-798-7811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHATTUCK",
        "first_name": "JENNIFER",
        "middle_name": "ANNE",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "334772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02742863",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jennifer.shattuck@direct.lourdes.com",
            "affiliation": "N",
            "endpointDescription": "Lourdes Hospital",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "3101 Shippers Rd",
            "city": "Vestal",
            "state": "NY",
            "country_code": "US",
            "postal_code": "138502080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Maryann Serbonich, PHARM D
• Kahaan Shah
• Mahrukh Shahbaz
• Zaid Shakir, MD
• Mary Anne Sharrow, MSPT
• Andrea M Shaul, CPNP
• Rose M Shea, LMSW
• Derek James Sheffer, PHARM.D, RPH
• Corinne Sherwood, PHARM D
• Neelima A Sheth, MD

• Family Nurse Practitioner in Johnson City, NY
• Providers in Johnson City, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.