NPIMap

Individual provider Active NPI

Jeni Lyn Carrico, CRNP

  • Nurse Practitioner
  • Lexington Park, MD
National Provider Identifier
1205135787
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5009950 Issued in NC
Practice address
20945 Great Mills Rd
Suite 203
Lexington Park, MD 20653-4369
Phone
(301) 866-0080
Fax
(301) 866-0010
NPI assigned
Mar 23, 2011
Last updated
Apr 15, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5009950 NC Primary
Family Nurse Practitioner 363LF0000X R125002 MD

Addresses

Primary practice location

20945 Great Mills Rd
Suite 203
Lexington Park, MD 20653-4369

Mailing address

5213 S Alston Ave
Durham, NC 27713-4430
Phone (919) 620-4855

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180103002782 NC Practitioner - Nurse Practitioner 3375788714 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians

Practice addresses (Care Compare)

10950 Chapel Hill Rd
B
Morrisville, NC 27560-8852
Phone (919) 327-1630

2701 Pickett Rd
Durham, NC 27705-5688
Phone (919) 419-9600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Affiliated Physicians, Inc. Internal Medicine Current Accepting new patients
Duke University Affiliated Physicians, Inc Internal Medicine Current Accepting new patients
Duke University Affiliated Physicians, Inc. Internal Medicine CurrentSince Dec 11, 2017 Accepting new patients
Duke University Affiliated Physicians, Inc. Internal Medicine CurrentSince Dec 11, 2017 Accepting new patients
Duke University Affiliated Physicians Internal Medicine Past Accepting new patients
Duke Health Integrated Practice, Inc. Past Accepting new patients

Locations

1901 Hillandale Rd
Ste D
Durham, NC 27705
Phone (919) 383-4355

5213 S Alston Ave
Durham, NC 27713
Phone (919) 620-4700

5716 Fayetteville Rd
Durham, NC 27713
Phone (919) 572-1868

10950 Chapel Hill Rd
#B
Morrisville, NC 27560
Phone (919) 327-1630

10211 Alm St
Ste 1100
Raleigh, NC 27617
Phone (919) 385-1160

7021 Harps Mill Rd
Raleigh, NC 27615
Phone (919) 576-8480

7200 Creedmoor Rd
Ste 208
Raleigh, NC 27613
Phone (919) 327-1650

Interoperability endpoints

  • Direct secure messaging: jcarrico391539@direct.medicine.duke.edu

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

Hospital & facility affiliations 11

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": "1300838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618444800000",
    "number": "1205135787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5213 S ALSTON AVE",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277134430",
            "telephone_number": "919-620-4855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20945 GREAT MILLS RD",
            "address_2": "SUITE 203",
            "city": "LEXINGTON PARK",
            "state": "MD",
            "postal_code": "206534369",
            "telephone_number": "301-866-0080",
            "fax_number": "301-866-0010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRICO",
        "first_name": "JENI",
        "middle_name": "LYN",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-23",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5009950",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R125002",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington Park, MD

Sources for this page

Verify at the official NPI Registry.