Individual provider Active NPI

Jessica Vivier

  • In Home Supportive Care Agency
  • Las Vegas, NV
National Provider Identifier
1194330183
Registry record updated Sep 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Practice address
4080 E Lake Mead Blvd Ste B-111
Las Vegas, NV 89115-6466
Phone
(702) 629-8226
NPI assigned
Sep 15, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 15, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X NV Primary

Addresses

Primary practice location

4080 E Lake Mead Blvd Ste B-111
Las Vegas, NV 89115-6466

Mailing address

4080 E Lake Mead Blvd Ste B-111
Las Vegas, NV 89115-6466
Phone (702) 629-8226

Other identifiers 1

IdentifierTypeStateIssuer
7252120599MedicaidNV

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL 7252120599

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1600128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600128000000",
    "number": "1194330183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4080 E LAKE MEAD BLVD STE B-111",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891156466",
            "telephone_number": "702-629-8226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4080 E LAKE MEAD BLVD STE B-111",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891156466",
            "telephone_number": "702-629-8226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIVIER",
        "first_name": "JESSICA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-15",
        "last_updated": "2020-09-15",
        "certification_date": "2020-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7252120599",
            "state": "NV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "7252120599",
            "affiliation": "N",
            "address_1": "4080 E Lake Mead Blvd Ste B-111",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891156466",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.