Active NPI
Jesse Villanueva
- Family Nurse Practitioner
- Charlotte, NC
National Provider Identifier
1255737631
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 5841
- Practice address
- 200 South College Street
Suite 500
Charlotte, NC 28202-2067 - Phone
- (704) 302-8800
- Fax
- (704) 632-4001
- NPI assigned
- Nov 12, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 5841 | CT | Primary |
| Family Nurse Practitioner | 363LF0000X | 285489 | NC | |
| Family Nurse Practitioner | 363LF0000X | 5008751 | NC |
Addresses
Primary practice location
200 South College Street
Suite 500
Charlotte, NC 28202-2067
Mailing address
P.O.Box 601643
Charlotte, NC 28260-1643
Phone (704) 302-8800
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NP4174 | Medicaid | SC | |
| 1255737631 | Medicaid | NC |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 285489 | NC | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Absolute Outcomes, LLC | Past | Accepting new patients |
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488499200000",
"number": "1255737631",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O.BOX 601643",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282601643",
"telephone_number": "704-302-8800",
"fax_number": "704-632-4001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 SOUTH COLLEGE STREET",
"address_2": "SUITE 500",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282022067",
"telephone_number": "704-302-8800",
"fax_number": "704-632-4001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLANUEVA",
"first_name": "JESSE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-11-12",
"last_updated": "2017-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CT",
"license": "5841",
"primary": true
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NC",
"license": "285489",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NC",
"license": "5008751",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "NP4174",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1255737631",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.