NPIMap

Individual provider Active NPI

Johnlyn Olin Nettles, FNP

  • Family Nurse Practitioner
  • Florence, SC
National Provider Identifier
1053875807
Registry record updated Aug 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
22600 Issued in SC
Practice address
1925 Hoffmeyer Rd
Florence, SC 29501-4011
Phone
(843) 679-4214
NPI assigned
Jan 25, 2019
Last updated
Aug 2, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 22600 SC Primary
Student in an Organized Health Care Education/Training Program 390200000X SC

Addresses

Primary practice location

1925 Hoffmeyer Rd
Florence, SC 29501-4011

Mailing address

PO Box 603898
Charlotte, NC 28260-3898
Phone (843) 792-6200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190815000188 SC Practitioner - Nurse Practitioner 2567799422 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians

Practice addresses (Care Compare)

148 Sauls St
Lake City, SC 29560-2677
Phone (843) 374-3621

800 W Meeting St
Lancaster, SC 29720-2202
Phone (803) 286-1330

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.15 of 100Reported as group
Quality
83.18
Promoting interoperability
98
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
80.41 of 100Reported as group
Quality
64.93
Promoting interoperability
99
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
22600SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Family Care, Inc CurrentSince Jun 13, 2019 Accepting new patients
Carolina Family Care, Inc CurrentSince Jun 13, 2019 Accepting new patients
Musc Community Physicians CurrentSince Jan 30, 2022 Accepting new patients
Medical University Hospital Authority Current Accepting new patients
Medical University Hospital Authority CurrentSince Dec 1, 2020 Accepting new patients
Musc Community Physicians CurrentSince Jan 30, 2022 Accepting new patients
Medical University Hospital Authority CurrentSince Dec 1, 2020 Accepting new patients
Regional Medical Center of Orangeburg and Calhoun Counties Past Accepting new patients
Medical University Hospital Authority Past Accepting new patients

Locations

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

1 Medical Park Dr
Chester, SC 29706
Phone (803) 581-3151

1925 Hoffmeyer Rd
Florence, SC 29501
Phone (843) 661-4390

148 Sauls St
Ste E
Lake City, SC 29560
Phone (843) 374-3621

800 W Meeting St
Lancaster, SC 29720
Phone (803) 286-1214

1341 Old Georgetown Rd
Ste C
Mt Pleasant, SC 29464
Phone (843) 884-2175

511 S Main St
Mullins, SC 29574
Phone (843) 464-8244

Interoperability endpoints

  • Direct secure messaging: jnettles253207@direct.musc.edu

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1548374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564704000000",
    "number": "1053875807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603898",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603898",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 HOFFMEYER RD",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295014011",
            "telephone_number": "843-679-4214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NETTLES",
        "first_name": "JOHNLYN",
        "middle_name": "OLIN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-25",
        "last_updated": "2019-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "22600",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "SC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, SC

Sources for this page

Verify at the official NPI Registry.