Individual provider Active NPI

Jessica Rae Depass, ARNP

  • Family Nurse Practitioner
  • Lynden, WA
National Provider Identifier
1124858238
Registry record updated Nov 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP61595445 Issued in WA
Practice address
1610 Grover St Ste D1
Lynden, WA 98264-1539
Phone
(360) 354-1333
NPI assigned
Aug 5, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2024

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 AP61595445 WA Primary

Addresses

Primary practice location

1610 Grover St Ste D1
Lynden, WA 98264-1539

Mailing address

1610 Grover St Ste D1
Lynden, WA 98264-1539
Phone (360) 354-1333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20241113002285 WA Practitioner - Nurse Practitioner 6002340072 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Care Network, PLLCGroup PAC ID 0446142046, 124 clinicians
Select Outpatient Services IncGroup PAC ID 4082868815, 750 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

1610 Grover St
Suite D1
Lynden, WA 98264-1539
Phone (360) 312-3785

2600 Compass Rd
Glenview, IL 60026-8001

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP61595445WAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Family Care Network PLLC CurrentSince Dec 2, 2024 Accepting new patients
Family Care Network PLLC CurrentSince Dec 2, 2024 Accepting new patients

Locations

1610 Grover St
Ste D1
Lynden, WA 98264
Phone (360) 312-3785

Interoperability endpoints

  • Direct secure messaging: jdepass22928@direct.fcn.net

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 and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1722816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732665600000",
    "number": "1124858238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 GROVER ST STE D1",
            "city": "LYNDEN",
            "state": "WA",
            "postal_code": "982641539",
            "telephone_number": "360-354-1333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 GROVER ST STE D1",
            "city": "LYNDEN",
            "state": "WA",
            "postal_code": "982641539",
            "telephone_number": "360-354-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEPASS",
        "first_name": "JESSICA",
        "middle_name": "RAE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-05",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61595445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynden, WA

Sources for this page

Verify at the official NPI Registry.