Individual provider Active NPI

Jennifer R Mammen, NP

  • Nurse Practitioner
  • Portsmouth, RI
National Provider Identifier
1154540243
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN01824 Issued in RI
Practice address
2444 E Main Rd
Portsmouth, RI 02871-4025
Phone
(401) 683-4817
NPI assigned
Apr 25, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 335104 NY
Nurse Practitioner 363L00000X APRN01824 RI Primary

Addresses

Primary practice location

2444 E Main Rd
Portsmouth, RI 02871-4025

Mailing address

200 Mill Rd
Fairhaven, MA 02719-5252
Phone (508) 973-2000

Other identifiers 1

IdentifierTypeStateIssuer
02892840MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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
I20201019002588 RI Practitioner - Nurse Practitioner 8628082666 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Massachusetts Medical School, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southcoast Physicians Group IncGroup PAC ID 0749171957, 875 clinicians

Practice addresses (Care Compare)

2444 E Main Rd
Southcoast Physicians Group Inc
Portsmouth, RI 02871-4025
Phone (401) 683-4817

Hospital & facility affiliations

  • Southcoast Hospitals Group Hospital, Fall River, MA, CCN 220074
  • Newport Hospital Hospital, Newport, RI, CCN 410006

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southcoast Physicians Group, Inc. CurrentSince Mar 1, 2023 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Mar 1, 2023 Accepting new patients
Jordan Physician Associates, Inc. Past Accepting new patients
Jordan Physician Associates, Inc. Past Accepting new patients

Locations

11 Friendship St
Newport, RI 02840
Phone (401) 845-1110

2444 E Main Rd
Portsmouth, RI 02871
Phone (401) 683-4817

Interoperability endpoints

  • Direct secure messaging: jmammen67719@direct.southcoast.org

Organizations & group practices 4

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 2

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": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1154540243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MILL RD",
            "city": "FAIRHAVEN",
            "state": "MA",
            "postal_code": "027195252",
            "telephone_number": "508-973-2000",
            "fax_number": "508-973-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2444 E MAIN RD",
            "city": "PORTSMOUTH",
            "state": "RI",
            "postal_code": "028714025",
            "telephone_number": "401-683-4817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMMEN",
        "first_name": "JENNIFER",
        "middle_name": "R",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-25",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "335104",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "RI",
            "license": "APRN01824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02892840",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, RI

Sources for this page

Verify at the official NPI Registry.