Individual provider Active NPI

Jaclyn Palmisano

  • Certified Registered Nurse Anesthetist
  • Camden, NJ
National Provider Identifier
1154964716
Registry record updated Feb 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
26NJ00974700 Issued in NJ
Practice address
1600 Haddon Ave FL 3
Camden, NJ 08103-3101
Phone
(856) 988-6260
NPI assigned
Oct 25, 2019
Last updated
Feb 11, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X 26NJ00974700 NJ
Certified Registered Nurse Anesthetist 367500000X 26NJ00974700 NJ Primary

Addresses

Primary practice location

1600 Haddon Ave FL 3
Camden, NJ 08103-3101

Mailing address

301 Lippincott Dr Ste 410
Marlton, NJ 08053-4197
Phone (856) 355-0340

Other practice location 1

1600 Haddon Ave
Camden, NJ 08103-3101
Phone (856) 757-3500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200122002899 NJ Practitioner - Certified Registered Nurse Anesthetist (Crna) 6204261142 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Virtua Medical Group, PAGroup PAC ID 9830222397, 1,678 clinicians

Practice addresses (Care Compare)

1600 Haddon Ave
Camden, NJ 08103-3101

3242 Route 206
Bordentown, NJ 08505-4517

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
26NJ00974700NJMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Atlantic Anesthesia Associates PA Single Specialty CurrentSince Jan 6, 2020 Accepting new patients
Virtua Medical Group, PA Single Specialty Current Accepting new patients
Virtua Medical Group, PA Nurse Practitioner CurrentSince Mar 1, 2025 Accepting new patients
Virtua Medical Group, PA CurrentSince Mar 1, 2025 Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

1600 Haddon Ave
Camden, NJ 08103
Phone (609) 757-3500

1600 Haddon Ave
#L
Camden, NJ 08103
Phone (856) 757-3500

1600 Haddon Ave
Fl 3
Camden, NJ 08103
Phone (609) 988-6260

301 Lippincott Dr
Ste 410
Marlton, NJ 08053

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1571961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739232000000",
    "number": "1154964716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 LIPPINCOTT DR STE 410",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534197",
            "telephone_number": "856-355-0340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 HADDON AVE FL 3",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081033101",
            "telephone_number": "856-988-6260"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 Haddon Ave",
            "address_purpose": "LOCATION",
            "city": "Camden",
            "state": "NJ",
            "postal_code": "081033101",
            "country_code": "US",
            "telephone_number": "856-757-3500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PALMISANO",
        "first_name": "JACLYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-25",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": "26NJ00974700",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NJ",
            "license": "26NJ00974700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Camden, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.