Jacqueline Selig, ANP
Individual provider Active NPI Adult Health Nurse Practitioner · Chinle, AZ
NPI 1134470628 · NPPES record last updated Sep 25, 2012
Key facts
- NPI
- 1134470628
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- AP60293807 (WA)
- Practice address
- Highway 191 and Hospital Road
Chinle, AZ 86503 - Phone
- (928) 674-7166
- Fax
- (928) 674-7705
- NPI assigned
- Sep 25, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- DHHS PHS Naihs Chinle Comprehensive Health Care Facility
Practice addresses (Care Compare)
Highway 191 and Hospital Rd
Chinle, AZ 86503-8000
Phone 92867470307030
PO Box PH
Chinle, AZ 86503-8000
Hospital & facility affiliations
- Chinle Comprehensive Health Care Facility
- Rehoboth McKinley Christian Health Care Services
Merit-based Incentive Payment System (MIPS)
- Final score
- 80.86 of 100
- Quality
- 61.32
- Improvement activities
- 40
- Cost
- 90.46
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130222000448 | TX | Practitioner - Nurse Practitioner | 8022263011 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP60293807 | WA | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DHHS PHS Naihs Chinle Comprehensive Health Care Facility | Current |
Accepting new patients | |
| DHHS PHS Naihs Chinle Comprehensive | Current |
Accepting new patients | |
| DHHS PHS Naihs Chinle Comprehensive Health Care Facility | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | AP60293807 | WA | Yes |
Addresses
Primary practice location
Highway 191 and Hospital Road
Chinle, AZ 86503
Mailing address
PO Box PH
Chinle, AZ 86503-8000
Phone (928) 674-7166
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AP60293807 | Other | WA | STATE LICENSE |
Other providers in Chinle, AZ
- Kathleen L Russell
- Anne Ryals
- Joseph S. Salay
- San Tan Behavioral Health Services
- Lindsey B Schultheiss-Harris
- Julia Sells
- Sequel Tsi of Az, LLC
- Valerie L Sharpe
- Allison Kali Shelton-Tahdooahnippah
- Benjamin Thomas Simms
All providers in Chinle, AZ · Adult Health Nurse Practitioner in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.