Jacquelynne M Kimani, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN2283682 Issued in MA

Practice address

40 Jackson St Ste 1050
Worcester, MA 01608-2313

Phone

(774) 420-8961

NPI assigned

Jan 2, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Raymond Zhou MD PCGroup PAC ID 6709927551, 3 clinicians

Behavioral Healthcare ServicesGroup PAC ID 3779818828, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Behavioral Healthcare Services

  • Psychiatry Physician
  • Worcester, MA
  • NPI 1346397437
  Medicare reassignment Care Compare group NPD
• Raymond Zhou MD PC

  • Internal Medicine Physician
  • Shrewsbury, MA
  • NPI 1831268820
  Medicare reassignment Care Compare group NPD
• Anchor Behavioral Health LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Chelmsford, MA
  • NPI 1649915612
  NPD Authorized official

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

{
    "created_epoch": "1609545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639872000000",
    "number": "1043808454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 JACKSON ST STE 1050",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016082313",
            "telephone_number": "774-420-8961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 JACKSON ST STE 1050",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016082313",
            "telephone_number": "774-420-8961"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "435 Shrewsbury St",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016041689",
            "country_code": "US",
            "telephone_number": "508-753-5554",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIMANI",
        "first_name": "JACQUELYNNE",
        "middle_name": "M",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-02",
        "last_updated": "2021-12-19",
        "certification_date": "2021-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2283682",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2283682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Anjeen Kim, NP
• Victoria Kim
• Young H Kim, M.D.
• Younghwa Kim, MA
• Anne Gitau Kimani
• Jane Kimani
• Florence N Kimanzi, COTA
• Francis Kimaru, RN/BSN
• Paulette R Kimball-Wren, MD
• Joyce Evalyn Hunt Kimball

• Psychiatric/Mental Health Nurse Practitioner in Worcester, MA
• Providers in Worcester, MA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 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.