Individual provider Active NPI

Jessica E Poitevint, CRNP

  • Family Nurse Practitioner
  • Enterprise, AL
National Provider Identifier
1063925626
Registry record updated Jun 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1-116339 Issued in AL
Practice address
105 E Watts St
Enterprise, AL 36330-2511
Phone
(334) 393-5437
Fax
(334) 393-4185
NPI assigned
Nov 6, 2017
Last updated
Jun 14, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2022

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 1-116339 AL Primary

Addresses

Primary practice location

105 E Watts St
Enterprise, AL 36330-2511

Mailing address

1414 Elba Hwy
Troy, AL 36079-6020
Phone (334) 670-6726

Other identifiers 1

IdentifierTypeStateIssuer
1-116339OtherALLICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20180425001058 AL Practitioner - Nurse Practitioner 7315201407 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

105 E Watts St
Enterprise, AL 36330-2511
Phone (334) 393-5437

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Alabama Rural Health Associates CurrentSince Feb 3, 2018 Accepting new patients
Southeast Alabama Rural Health Associates CurrentSince Feb 3, 2018 Accepting new patients
Southeast Alabama Rural Health Associates Past Accepting new patients

Locations

105 E Watts St
Enterprise, AL 36330
Phone (334) 393-5437

1412 Elba Hwy
Troy, AL 36079
Phone (334) 288-0814

1414 Elba Hwy
Troy, AL 36079
Phone (334) 670-6726

Interoperability endpoints

  • Direct secure messaging: jessica.poitevint@sarha.eclinicaldirectplus.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/CHFGBD

Organizations & group practices 3

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": "1509926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655164800000",
    "number": "1063925626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 ELBA HWY",
            "city": "TROY",
            "state": "AL",
            "postal_code": "360796020",
            "telephone_number": "334-670-6726",
            "fax_number": "334-670-6731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 E WATTS ST",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363302511",
            "telephone_number": "334-393-5437",
            "fax_number": "334-393-4185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POITEVINT",
        "first_name": "JESSICA",
        "middle_name": "E",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-06",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-116339",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "1-116339",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Enterprise, AL

Sources for this page

Verify at the official NPI Registry.