Individual provider Active NPI

Priscilla Jencks, LNM

  • Advanced Practice Midwife
  • New Haven, CT
National Provider Identifier
1174627236
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
000071 Issued in CT
Practice address
374 Grand Ave
Fair Haven Community Health Ctr
New Haven, CT 06513
Phone
(203) 777-7411
Fax
(203) 777-8604
NPI assigned
Sep 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X 000071 CT Primary

Addresses

Primary practice location

374 Grand Ave
Fair Haven Community Health Ctr
New Haven, CT 06513

Mailing address

87 Ingram Street
Hamden, CT 06517
Phone (203) 287-9706

Other identifiers 4

IdentifierTypeStateIssuer
0000254189301OtherUNITED HEALTHCARE
0000719734OtherCT CARE
P3597631OtherOXFORD
400000071CT01OtherANTHEM BCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080708000314 CT Practitioner - Certified Nurse Midwife (CNM) 6406928456 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Nurse Midwife (CNM)
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 James St
New Haven, CT 06513-4222
Phone (203) 777-7411

164 Grand Ave
New Haven, CT 06513-3938
Phone (203) 777-7411

293 Clinton Ave
New Haven, CT 06513-2814
Phone (203) 777-7411

339 Eastern St
BLDG B
New Haven, CT 06513-2463
Phone (203) 777-7411

35 Wheelbarrow LN
East Haven, CT 06513-2003
Phone (203) 777-7411

374 Grand Ave
New Haven, CT 06513-3733
Phone (203) 777-7411

374 Grand Ave
New Haven, CT 06513-3787

50 Grand Ave
New Haven, CT 06513-3949
Phone (203) 777-7411

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Yale University CurrentSince Mar 7, 2020 Accepting new patients
Fair Haven Community Health Clinic Inc CurrentSince Mar 10, 2011 Accepting new patients
Yale University CurrentSince Mar 7, 2020 Accepting new patients
Fair Haven Community Health Clinic, Inc CurrentSince Mar 10, 2011 Accepting new patients
Saint Raphael Faculty Physicians Past Accepting new patients
Saint Raphael Healthcare System Affiliated Physicians Inc Advanced Practice Midwife Past Accepting new patients

Locations

374 Grand Ave
New Haven, CT 06513
Phone (203) 752-5203

1354 Chapel St
New Haven, CT 06511
Phone (203) 867-8300

800 Howard Ave
New Haven, CT 06519
Phone (203) 785-2140

1450 Chapel St
New Haven, CT 06511
Phone (203) 789-3151

50 Division St
New Haven, CT 06511
Phone (203) 785-2140

Interoperability endpoints

  • Direct secure messaging: pjencks41422@direct.ynhh.org

Organizations & group practices 6

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174627236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "87 INGRAM STREET",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "06517",
            "telephone_number": "203-287-9706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "374 GRAND AVE",
            "address_2": "FAIR HAVEN COMMUNITY HEALTH CTR",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "06513",
            "telephone_number": "203-777-7411",
            "fax_number": "203-777-8604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENCKS",
        "first_name": "PRISCILLA",
        "credential": "LNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "CT",
            "license": "000071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "0000254189301",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CT CARE",
            "identifier": "0000719734",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P3597631",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "400000071CT01",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.