NPIMap

Individual provider Active NPI

Jacqueline Antoinette Hudak, FNP

  • Family Nurse Practitioner
  • Seneca, SC
National Provider Identifier
1104216233
Registry record updated Jun 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
19302 Issued in SC
Practice address
298 Memorial Dr
Seneca, SC 29672-9443
Phone
(864) 885-7758
Fax
(864) 885-7749
NPI assigned
Jan 27, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2021

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 19302 SC Primary

Addresses

Primary practice location

298 Memorial Dr
Seneca, SC 29672-9443

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603

Other practice location 1

704 N Pine St
Seneca, SC 29678-2637
Phone (864) 886-9300

Other identifiers 1

IdentifierTypeStateIssuer
NP3182MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jhudak128839@direct.ghs.myhfn.org Direct

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
I20150414001890 SC Practitioner - Nurse Practitioner 4789902123 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Georgetown University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prisma Health University Medical GroupGroup PAC ID 8325950983, shared by 5 NPIs, 2,467 clinicians

Practice addresses (Care Compare)

704 N Pine St
Seneca, SC 29678-2637
Phone (864) 886-9300

772 N Townville St
Seneca, SC 29678-2645
Phone (864) 886-9300

Hospital & facility affiliations

  • Prisma Health Oconee Memorial Hospital Hospital, Seneca, SC, CCN 420009
  • Prisma Health Greenville Memorial Hospital Hospital, Greenville, SC, CCN 420078

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19302SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Greenville Health System CurrentSince Mar 30, 2015 Accepting new patients
Prisma Health University Medical Group Current Accepting new patients
Prisma Health University Medical Group CurrentSince Oct 1, 2016 Accepting new patients
Prisma Health University Medical Group CurrentSince Mar 1, 2015 Accepting new patients
Greenville Health System CurrentSince Mar 30, 2015 Accepting new patients
Greenville Health System Current Accepting new patients
GHS Partners in Health, Inc. CurrentSince Mar 1, 2015 Accepting new patients

Locations

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

1 Independence Pt
Ste 212
Greenville, SC 29615
Phone (864) 797-6306

2A Cleveland Ct
Greenville, SC 29607
Phone (864) 271-7761

298 Memorial Dr
Seneca, SC 29672
Phone (864) 482-3100

10110 Clemson Blvd
Seneca, SC 29678
Phone (864) 482-0500

772 N Townville St
Seneca, SC 29678
Phone (864) 886-9300

Interoperability endpoints

  • Direct secure messaging: jhudak128839@direct.ghs.myhfn.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 42

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

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1422316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1104216233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "298 MEMORIAL DR",
            "city": "SENECA",
            "state": "SC",
            "postal_code": "296729443",
            "telephone_number": "864-885-7758",
            "fax_number": "864-885-7749"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "704 N Pine St",
            "address_purpose": "LOCATION",
            "city": "Seneca",
            "state": "SC",
            "postal_code": "296782637",
            "country_code": "US",
            "telephone_number": "864-886-9300",
            "fax_number": "864-886-9399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUDAK",
        "first_name": "JACQUELINE",
        "middle_name": "ANTOINETTE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-27",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "19302",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP3182",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jhudak128839@direct.ghs.myhfn.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jhudak128839@direct.ghs.myhfn.org",
            "address_1": "298 Memorial Dr",
            "city": "Seneca",
            "state": "SC",
            "country_code": "US",
            "postal_code": "296729443",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Seneca, SC

Sources for this page

Verify at the official NPI Registry.