Jenni Lisa Hackenberg

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

25116 Issued in SC

Practice address

1709 Old Trolley Rd
Summerville, SC 29485-8276

Phone

(843) 873-2225

NPI assigned

Jun 30, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in VA

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Rejuvinix, LLC

  • Physical Medicine & Rehabilitation Physician
  • Virginia Beach, VA
  • NPI 1710409529
  Medicare reassignment NPD
• Dr Drew K McPhail Chiropractor

  • Chiropractor
  • Summerville, SC
  • NPI 1083755755
  NPD (past)

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

{
    "created_epoch": "1625011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1235709395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 VAN BUREN DR",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294860405",
            "telephone_number": "803-522-4570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1709 OLD TROLLEY RD",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294858276",
            "telephone_number": "843-873-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKENBERG",
        "first_name": "JENNI",
        "middle_name": "LISA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-30",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "25116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jenni@mcphailclinic.com",
            "affiliation": "N",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1709 Old Trolley Rd",
            "city": "Summerville",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294858276",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "jenni@mcphailclinic.com",
            "affiliation": "N",
            "address_1": "1709 Old Trolley Rd",
            "city": "Summerville",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294858276",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Wallace Lyndon Guilford III, D.M.D.
• Tory R Guilliam, DPT
• Alexandra Gumen, RDN
• Alyssa Gustafson, RDH
• Veronica Guy, DMD
• Rebecca D Hackett, LPC
• Claudia M Hafer
• Deborah Elizabeth Haffner, DMD
• Jennie Ellis Haithcock, DPT
• Tayo E Haiyede, DMSC, PA-C.

• Family Nurse Practitioner in Summerville, SC
• Providers in Summerville, SC by specialty
• Family Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.