Active NPI
Jamie C. Mortellite, NURSE PRACTITIONER
- Acute Care Nurse Practitioner
- Boston, MA
National Provider Identifier
1295855450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- 254663
- Practice address
- 330 Brookline Ave
Boston, MA 02215-5400 - Phone
- (617) 667-1949
- Fax
- (617) 667-9922
- NPI assigned
- Mar 30, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 254663 | MA | Primary |
Addresses
Primary practice location
330 Brookline Ave
Boston, MA 02215-5400
Mailing address
46 Lowell Rd
North Reading, MA 01864-1632
Phone (781) 910-0322
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 94036 | Other | MA | FALLON |
| NP4995 | Other | MA | BLUE CARE 65 |
| 21258700817 | Other | MA | BEECH STREET |
| 0703095 | Medicaid | MA | |
| NP4995 | Other | MA | BLUE CARE ELECT |
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 254663 | MA | MD | Acute Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295855450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "46 LOWELL RD",
"city": "NORTH READING",
"state": "MA",
"postal_code": "018641632",
"telephone_number": "781-910-0322",
"fax_number": "617-667-9922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 BROOKLINE AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "022155400",
"telephone_number": "617-667-1949",
"fax_number": "617-667-9922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORTELLITE",
"first_name": "JAMIE",
"middle_name": "C.",
"name_prefix": "Ms.",
"credential": "NURSE PRACTITIONER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "MA",
"license": "254663",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FALLON",
"identifier": "94036",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE 65",
"identifier": "NP4995",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEECH STREET",
"identifier": "21258700817",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0703095",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE ELECT",
"identifier": "NP4995",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.