Active NPI
Jaclyn Pereira, FNP-BC, APRN
- Family Nurse Practitioner
- Palm Beach Gardens, FL
National Provider Identifier
1144095977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 95028125
- Practice address
- 2701 Ravella Way
Palm Beach Gardens, FL 33410-2966 - Phone
- (561) 420-5097
- NPI assigned
- Nov 21, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 95028125 | CA | Primary |
Addresses
Primary practice location
2701 Ravella Way
Palm Beach Gardens, FL 33410-2966
Mailing address
2701 Ravella Way
Palm Beach Gardens, FL 33410-2966
Phone (561) 420-5097
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL, CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
18880 Cherry Valley Blvd
Tuolumne, CA 95379-9506
Phone (209) 928-5400
Hospital & facility affiliations
- Adventist Health Sonora
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95028125 | CA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tuolumne Mewuk Indian Health Center, Inc | Family | Current | Accepting new patients |
| Tuolumne Me-Wuk Indian Health Center, Inc. | Current | Accepting new patients |
Locations
18880 Cherry Valley Blvd
Tuolumne, CA 95379
Phone (209) 928-5400
Interoperability endpoints
- jaclyn.pereira.p1@direct.tmwihc.nextgenshare.com
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Tuolumne, CA
- NPI 1619952397
-
- Family Medicine Physician
- Sonora, CA
- NPI 1124286885
Hospital & facility affiliations 12
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Sonora, CA
- NPI 1780673376
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1700524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700524800000",
"number": "1144095977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2701 RAVELLA WAY",
"city": "PALM BEACH GARDENS",
"state": "FL",
"postal_code": "334102966",
"telephone_number": "561-420-5097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2701 RAVELLA WAY",
"city": "PALM BEACH GARDENS",
"state": "FL",
"postal_code": "334102966",
"telephone_number": "561-420-5097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREIRA",
"first_name": "JACLYN",
"credential": "FNP-BC, APRN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-11-21",
"last_updated": "2023-11-21",
"certification_date": "2023-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "95028125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palm Beach Gardens, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2023; 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.