Individual provider Active NPI

Jennifer Alicia Myers-Cassidy, FNP-BC

  • Nurse Practitioner
  • Winston Salem, NC
National Provider Identifier
1275012742
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
227051 Issued in NC
Practice address
950 Reynolds Blvd
Winston Salem, NC 27105-3450
Phone
(808) 633-6070
Fax
(336) 232-9683
NPI assigned
Aug 7, 2018
Last updated
Dec 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 227051 NC Primary

Addresses

Primary practice location

950 Reynolds Blvd
Winston Salem, NC 27105-3450

Mailing address

352 McClamrock Rd
Mocksville, NC 27028-4257
Phone (808) 633-6070

Other practice location 1

305 E Lee Ave
Yadkinville, NC 27055-8132
Phone (336) 679-2661

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jmyerscassidy@marathon-health.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181211001785 NC Practitioner - Nurse Practitioner 3678817178 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

100 Robinhood Medical PLZ
Winston Salem, NC 27106-5476
Phone (336) 718-0800

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Forsyth Memorial Hospital, Inc. Current Accepting new patients
Forsyth Memorial Hospital Inc CurrentSince Nov 12, 2018 Accepting new patients
Forsyth Memorial Hospital, Inc. CurrentSince Nov 12, 2018 Accepting new patients
Forsyth Memorial Hospital, Inc Past Accepting new patients

Locations

6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473

291 Broad St
Kernersville, NC 27284
Phone (336) 993-8181

485 Valley Rd
Mocksville, NC 27028
Phone (336) 751-8000

100 Robinhood Medical Plz
Winston Salem, NC 27106
Phone (336) 718-0560

305 E Lee Ave
Yadkinville, NC 27055
Phone (336) 679-2661

Interoperability endpoints

  • Direct secure messaging: jen.myers-cassidy.2@14940.direct.athenahealth.com
  • Direct secure messaging: jmyers125691@direct.novanthealth.org
  • Direct secure messaging: jmyerscassidy@marathon-health.com

Organizations & group practices 4

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 1

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": "1533600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1275012742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "352 MCCLAMROCK RD",
            "city": "MOCKSVILLE",
            "state": "NC",
            "postal_code": "270284257",
            "telephone_number": "808-633-6070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 REYNOLDS BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271053450",
            "telephone_number": "808-633-6070",
            "fax_number": "336-232-9683"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "305 E Lee Ave",
            "address_purpose": "LOCATION",
            "city": "Yadkinville",
            "state": "NC",
            "postal_code": "270558132",
            "country_code": "US",
            "telephone_number": "336-679-2661",
            "fax_number": "336-679-7056",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MYERS-CASSIDY",
        "first_name": "JENNIFER",
        "middle_name": "ALICIA",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-07",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "227051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmyerscassidy@marathon-health.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "950 Reynolds Blvd",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271053450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.