Individual provider Active NPI

Jessica Fernandes Canuto, AGNP-C

  • Geriatric Medicine (Family Medicine) Physician
  • Brockton, MA
National Provider Identifier
1154134393
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
RN2361476 Issued in MA
Practice address
45 Edson St
Brockton, MA 02302-4109
Phone
(774) 274-1882
NPI assigned
Jan 30, 2025
Last updated
Jan 30, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X RN2361476 MA Primary

Addresses

Primary practice location

45 Edson St
Brockton, MA 02302-4109

Mailing address

45 Edson St
Brockton, MA 02302-4109

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20250428000612 MA Practitioner - Nurse Practitioner 7012433691 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment
Group practices
Hughes Health and WellnessGroup PAC ID 4486053121, 3 clinicians

Practice addresses (Care Compare)

168 Raymond Rd
Plymouth, MA 02360-2357
Phone (508) 747-0780

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Hughes Health and Wellness Single Specialty CurrentSince Feb 8, 2025 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1738195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1154134393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 EDSON ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023024109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 EDSON ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023024109",
            "telephone_number": "774-274-1882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANUTO",
        "first_name": "JESSICA",
        "middle_name": "FERNANDES",
        "credential": "AGNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-01-30",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "MA",
            "license": "RN2361476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.