NPIMap

Individual provider Active NPI

Jenny Davis, FNP

  • Family Nurse Practitioner
  • New York, NY
National Provider Identifier
1104173632
Registry record updated May 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F342969 Issued in NY
Practice address
350 Grand St
New York, NY 10002-4629
Phone
(212) 634-7550
Fax
(646) 935-4665
NPI assigned
Aug 15, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2018

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 CNP121060 ME
Family Nurse Practitioner 363LF0000X F342969 NY Primary

Addresses

Primary practice location

350 Grand St
New York, NY 10002-4629

Mailing address

60 Madison Ave FL 5
New York, NY 10010-1600
Phone (212) 545-2438

Other practice location 1

7 School St
Albion, ME 04910
Phone (207) 437-9388

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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
I20120925000503 ME Practitioner - Nurse Practitioner 6709035314 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

16 Fahy St
Suite 103
Belfast, ME 04915-6029
Phone (207) 338-5440

Hospital & facility affiliations

  • Mainehealth Home Health and Hospice Home health agency, Saco, ME, CCN 207000
  • Mainehealth Home Health and Hospice Hospice, Rockport, ME, CCN 201508
  • Mainehealth Waldo Hospital Hospital, Belfast, ME, CCN 201312

Merit-based Incentive Payment System (MIPS)

Final score
97.93 of 100Reported as apm
Quality
83.31
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F342969NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth Current Accepting new patients
Mainehealth CurrentSince Jun 1, 2020 Accepting new patients
Mainehealth CurrentSince Jun 1, 2020 Accepting new patients
Healthreach Community Health Centers Past Accepting new patients
Community Healthcare Network, Inc. Past Accepting new patients
Healthreach Community Health Centers Past Accepting new patients

Locations

118 Northport Ave
Belfast, ME 04915
Phone (207) 338-9345

116 Northport Ave
Ste 220
Belfast, ME 04915
Phone (207) 505-4015

16 Fahy St
Ste 103
Belfast, ME 04915
Phone (207) 338-5440

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

Interoperability endpoints

  • Direct secure messaging: jdavis107347@direct.mmc.mainehealth.org

Organizations & group practices 7

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.

Hospital & facility affiliations 3

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": "1344988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527724800000",
    "number": "1104173632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 MADISON AVE FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100101600",
            "telephone_number": "212-545-2438",
            "fax_number": "646-312-0481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 GRAND ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100024629",
            "telephone_number": "212-634-7550",
            "fax_number": "646-935-4665"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7 School St",
            "address_purpose": "LOCATION",
            "city": "Albion",
            "state": "ME",
            "postal_code": "04910",
            "country_code": "US",
            "telephone_number": "207-437-9388",
            "fax_number": "207-437-2557",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JENNY",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-15",
        "last_updated": "2018-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ME",
            "license": "CNP121060",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F342969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.