Jody Puckett Crisp, MSN-FNP
Individual provider Active NPI Family Nurse Practitioner · Flat Rock, NC
NPI 1275183147 · NPPES record last updated Aug 17, 2022
Key facts
- NPI
- 1275183147
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 5012460 (NC)
- Practice address
- 571 S Allen Rd
Flat Rock, NC 28731-9447 - Phone
- (828) 692-6178
- Fax
- (828) 692-2365
- NPI assigned
- Sep 12, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Outer Banks Professional Services, LLC
Practice addresses (Care Compare)
5002 S Croatan Hwy
Suite a
Nags Head, NC 27959-9045
Phone (252) 449-6115
Merit-based Incentive Payment System (MIPS)
- Final score
- 96.95 of 100
- Quality
- 82.44
- Promoting interoperability
- 100
- Improvement activities
- 40
Merit-based Incentive Payment System (MIPS)
- Final score
- 96.95 of 100
- Quality
- 82.44
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191216000323 | NC | Practitioner - Nurse Practitioner | 4183057664 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Outer Banks Professional Services, LLC | Current |
Accepting new patients | |
| Vidant Medical Group LLC | Current |
Accepting new patients | |
| Outer Banks Professional Services, LLC | Current |
Accepting new patients | |
| Vidant Medical Group LLC | Current |
Accepting new patients |
Locations
401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941
4800 S Croatan Hwy
Nags Head, NC 27959
Phone (252) 449-4500
5002 S Croatan Hwy
Ste A
Nags Head, NC 27959
Phone (252) 449-6115
5565 N Croatan Hwy
Southrn Shore, NC 27949
Phone (252) 261-5800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 5012460 | NC | |
| Family Nurse Practitioner | 363LF0000X | 5012460 | NC | Yes |
Addresses
Primary practice location
571 S Allen Rd
Flat Rock, NC 28731-9447
Mailing address
571 S Allen Rd
Flat Rock, NC 28731-9447
Phone (828) 692-6178
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jcrisp2@fourseasonscfl.org |
Other providers in Flat Rock, NC
- Yesmira Sun Chia
- Allison Grace Christian
- Valerie Clark
- Seth Cohen
- Flor De Maria Corbett
- Lorena E Dascalescu
- Cristina Helena Davis
- Bonnie Muzenic Dean
- Anthony Paul Dietrich
- Allison Brewster Dimond
All providers in Flat Rock, NC · Family Nurse Practitioner in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.