Jacqueline Mintz, ARNP-FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN213453 Issued in GA

Practice address

524 Nelson Ave
Shaw Afb, SC 29152

Phone

(706) 495-6612

NPI assigned

Jul 14, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

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

Specialty

Nurse Practitioner

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

South Carolina Dept of Mental Health Accounting OfficeGroup PAC ID 9032021175, 226 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• South Carolina Dept of Mental Health Accounting Office

  • Psychiatric Hospital
  • Anderson, SC
  • NPI 1376595041

  SC

  Medicare reassignment Care Compare group NPD
• South Carolina Dept of Mental Health Accounting Office

  • Community/Behavioral Health Agency
  • Columbia, SC
  • NPI 1083421994
  NPD
• South Carolina Dept of Mental Health Accounting Office

  • Substance Abuse Rehabilitation Facility
  • Columbia, SC
  • NPI 1295787869
  NPD

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

{
    "created_epoch": "1247529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324425600000",
    "number": "1124258967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 ASHLEY PLACE ROAD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29229",
            "telephone_number": "706-495-6612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 NELSON AVE",
            "city": "SHAW AFB",
            "state": "SC",
            "postal_code": "29152",
            "telephone_number": "706-495-6612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINTZ",
        "first_name": "JACQUELINE",
        "credential": "ARNP-FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-14",
        "last_updated": "2011-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "KS",
            "license": "14-60208-122",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN213453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keasha Martin
• Gina G Mathews, LCSW-C
• Lauren Mattmuller, DMD
• Shanna Marie May, LISW-CP, LAC
• Seann Meyer, DMD
• National Vision, Inc.
• Megan Nguyen
• Samantha Nixon, DMD
• Alexander William Ortiz, DO
• Logan Parrott, M.D.

• Family Nurse Practitioner in Shaw Afb, SC
• Providers in Shaw Afb, SC by specialty
• Family Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.