Jacqueline C Martin, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

005215 Issued in CT

Practice address

26 Chamberlain Hwy
Kensington, CT 06037-1921

Phone

(860) 893-0040

Fax

(860) 893-0046

NPI assigned

Nov 10, 2012

Last updated

May 26, 2021By the provider in NPPES

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

Other identifiers 1

Other names 1

• Jacqueline C Ercole Former name

Medicare fee-for-service enrollment

Enrolled in CT

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

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Paragon Behavioral Health, LLCGroup PAC ID 1850301508, 10 clinicians

Practice addresses (Care Compare)

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.

• Paragon Behavioral Health, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Kensington, CT
  • NPI 1972620961
  Medicare reassignment Care Compare group NPD
• Paragon Behavioral Health, LLC

  • Clinical Psychologist
  • Kensington, CT
  • NPI 1023135019
  NPD
• Paragon Behavioral Health, LLC

  • Marriage & Family Therapist
  • Berlin, CT
  • NPI 1629890553
  NPD

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

{
    "created_epoch": "1352505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1306180542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 CHAMBERLAIN HWY",
            "city": "KENSINGTON",
            "state": "CT",
            "postal_code": "060371921",
            "telephone_number": "860-893-0040",
            "fax_number": "860-893-0046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 CHAMBERLAIN HWY",
            "city": "KENSINGTON",
            "state": "CT",
            "postal_code": "060371921",
            "telephone_number": "860-893-0040",
            "fax_number": "860-893-0046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "JACQUELINE",
        "middle_name": "C",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-10",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "005215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008042980",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "ERCOLE",
            "middle_name": "C",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Eang B. Keo, RPH
• Ledgecrest Health Care Center Inc. (Ledgecrest Health Care Inc)
• Ruth Lerro
• Jordyn Murphy Magill, PHARMD
• Erin Leah Martin, LCSW
• Samantha C Matus, DMD
• Claudio Negrao II, PHD
• Sydney M Neubieser, DC
• Richard V Niego, DMD
• Paul George Ohanesian, MFT

• Psychiatric/Mental Health Nurse Practitioner in Kensington, CT
• Providers in Kensington, CT by specialty
• Psychiatric/Mental Health Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.