Individual provider Active NPI

Jill T. Jesurum, ARNP, PHD

  • Nurse Practitioner
  • Seattle, WA
National Provider Identifier
1194809806
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP30005750 Issued in WA
Practice address
1100 9TH Ave
Seattle, WA 98101-2756
Phone
(206) 223-6198
Fax
(206) 341-0591
NPI assigned
Oct 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP30005750 WA
Nurse Practitioner 363L00000X AP30005750 WA Primary

Addresses

Primary practice location

1100 9TH Ave
Seattle, WA 98101-2756

Mailing address

PO Box 741515
Los Angeles, CA 90074-1515
Phone (206) 223-6198

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jjesurum1042027@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
AP30005750WAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Virginia Mason Medical Center Current Accepting new patients

Locations

380 Winslow Way E
Bainbridge Island, WA 98110
Phone (206) 842-5632

925 Seneca St
Seattle, WA 98101
Phone (206) 341-0860

1100 9th Ave
Seattle, WA 98101
Phone (206) 223-6980

Organizations & group practices 1

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": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1194809806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 741515",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900741515",
            "telephone_number": "206-223-6198",
            "fax_number": "206-341-0591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 9TH AVE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981012756",
            "telephone_number": "206-223-6198",
            "fax_number": "206-341-0591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JESURUM",
        "first_name": "JILL",
        "middle_name": "T.",
        "credential": "ARNP, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP30005750",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP30005750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jjesurum1042027@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "550 17th Ave",
            "address_2": "6th Floor",
            "city": "Seattle",
            "state": "WA",
            "country_code": "US",
            "postal_code": "981225788",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.