Individual provider Active NPI

Jessica F Niese, NP

  • Family Nurse Practitioner
  • Sandusky, OH
National Provider Identifier
1063862688
Registry record updated Jun 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
COA.19168-NP Issued in OH
Practice address
1200 Sycamore Line
Sandusky, OH 44870-4029
Phone
(419) 625-5269
NPI assigned
Jun 14, 2016
Last updated
Jun 14, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X COA.19168-NP OH Primary

Addresses

Primary practice location

1200 Sycamore Line
Sandusky, OH 44870-4029

Mailing address

1200 Sycamore Line
Sandusky, OH 44870-4029
Phone (419) 625-5269

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20161117001458 OH Practitioner - Nurse Practitioner 9537448469 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Incare Health Solutions LLCGroup PAC ID 5092980730, 66 clinicians

Practice addresses (Care Compare)

2562 W Market St
Tiffin, OH 44883-9005
Phone (567) 938-8008

525 Chestnut Commons Dr
Elyria, OH 44035-9611
Phone (440) 406-8153

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
COA.19168-NPOHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Incare Health Solutions LLC CurrentSince Jan 14, 2017 Accepting new patients
Incare Health Solutions, LLC Family CurrentSince Jan 14, 2017 Accepting new patients

Locations

175 Edgefield Blvd
Marion, OH 43302
Phone (740) 751-6433

7450 State Route 161 E
Plain City, OH 43064
Phone (614) 504-5002

2562 W Market St
Tiffin, OH 44883
Phone (567) 938-8008

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1465862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465862400000",
    "number": "1063862688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 SYCAMORE LINE",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448704029",
            "telephone_number": "419-625-5269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 SYCAMORE LINE",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448704029",
            "telephone_number": "419-625-5269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIESE",
        "first_name": "JESSICA",
        "middle_name": "F",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-14",
        "last_updated": "2016-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "COA.19168-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandusky, OH

Sources for this page

Verify at the official NPI Registry.