Jillian A Hodge, NP
Individual provider Active NPI Family Nurse Practitioner · Shell Knob, MO
NPI 1194254664 · NPPES record last updated Jul 3, 2017
Key facts
- NPI
- 1194254664
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 2017021980 (MO)
- Practice address
- 22361 Oak Ridge Dr
Shell Knob, MO 65747-7822 - Phone
- (417) 858-3731
- NPI assigned
- Jun 8, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mercy Clinic Springfield Communities
Practice addresses (Care Compare)
1605 Martin Springs Dr
Rolla, MO 65401-2980
92 Main St
Cassville, MO 65625-1610
Phone (417) 820-3911
Hospital & facility affiliations
- Mercy Hospital - Cassville
- Mercy Hospital Joplin
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170710001172 | MO | Practitioner - Nurse Practitioner | 1153690060 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2004036967 | MO | MD | Registered Nurse |
| 2017021980 | MO | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Clinic Springfield Communities | Current |
Accepting new patients | |
| Mercy Clinic Springfield Communities | Current |
Accepting new patients | |
| Mercy Clinic Springfield Communities | Family | Current |
Accepting new patients |
Locations
92 Main St
Cassville, MO 65625
Phone (417) 847-5225
1717 S Range Line Rd
Ste B
Joplin, MO 64804
Phone (417) 556-2231
1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379
1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379
22361 Oak Ridge Dr
Shell Knob, MO 65747
Phone (417) 858-3731
2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905
Interoperability endpoints
- jhodge949878@directc.mercy.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 2004036967 | MO | |
| Family Nurse Practitioner | 363LF0000X | 2017021980 | MO | Yes |
Addresses
Primary practice location
22361 Oak Ridge Dr
Shell Knob, MO 65747-7822
Mailing address
22361 Oak Ridge Dr
Shell Knob, MO 65747
Phone (855) 420-7900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | MO |
Other providers in Shell Knob, MO
- Cynthia Curatalo
- Randy Jackson Curl
- Georgann Marie Greissinger
- Aaron Guyer
- Patrick B. Harr
- Brian K. Leach
- Lester E Cox Medical Centers
- Lester E. Cox Medical Centers
- Robert Eugene McDougle
- Mercy Clinic-Springfield Communities
All providers in Shell Knob, MO · Family Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.