Jill Maria Scott, ARNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

6139 Issued in MN

Practice address

630 E Main St
Anoka, MN 55303

Phone

(763) 712-1903

Fax

(763) 712-1917

NPI assigned

Aug 26, 2014

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Aug 2, 2021 through Aug 2, 2027

Medicare enrollment (NPD)

Enrolled

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.

• Eastern Iowa Psychiatric Services PC

  • Psychiatric/Mental Health Nurse Practitioner
  • Cedar Rapids, IA
  • NPI 1073264248

  Psychiatric/Mental Health

  NPD Authorized official
• Genuine Therapy Center

  • Community/Behavioral Health Agency
  • Anoka, MN
  • NPI 1841493608
  NPD (past)
• Optiovillage, Inc

  • Community/Behavioral Health Agency
  • Anoka, MN
  • NPI 1184002784
  NPD (past)
• Boone County Hospital

  • Critical Access Hospital
  • Boone, IA
  • NPI 1467434225
  NPD (past)

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

{
    "created_epoch": "1409011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538956800000",
    "number": "1124428222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 E MAIN ST",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "553032527",
            "telephone_number": "763-712-1903",
            "fax_number": "763-712-1917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 E MAIN ST",
            "city": "ANOKA",
            "state": "MN",
            "postal_code": "55303",
            "telephone_number": "763-712-1903",
            "fax_number": "763-712-1917"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 10th St SE",
            "address_purpose": "LOCATION",
            "city": "Cedar Rapids",
            "state": "IA",
            "postal_code": "524031251",
            "country_code": "US",
            "telephone_number": "319-369-4777",
            "fax_number": "319-369-4694",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "701 10th St SE",
            "address_purpose": "LOCATION",
            "city": "Cedar Rapids",
            "state": "IA",
            "postal_code": "524031251",
            "country_code": "US",
            "telephone_number": "319-369-4777",
            "fax_number": "319-369-4694",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCOTT",
        "first_name": "JILL",
        "middle_name": "MARIA",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-08-26",
        "last_updated": "2018-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IA",
            "license": "G098882",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "6139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Gray Schultheis, DPT
• Kathy Schulz
• Angela Schutta, LGSW
• Anne Schweizer
• Kyle Schwieters
• Mpho P Sebonego, M.D.
• Gordon A. Seim, RPH
• Emily Selbitschka, MSW, LGSW
• Paige Servick, OTR/L
• Darell Matthew Shaffer, M.D.

• All providers in Anoka, MN
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.