Jill A Endicott, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

2004019593 Issued in MO

Practice address

3202 McIntosh Cir
Suite LL03
Joplin, MO 64804-3646

Phone

(417) 347-6400

Fax

(417) 347-6404

NPI assigned

Jul 3, 2006

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 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2023 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

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.

• Incontinence and Osteoporosis Center LLC

  • Gynecology Physician
  • Galena, KS
  • NPI 1225168206
  NPD
• Digestive Health Center of the Four States, LLC

  • Gastroenterology Physician
  • Galena, KS
  • NPI 1053754986
  NPD (past)

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426464000000",
    "number": "1306876818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3810",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648033810",
            "telephone_number": "417-347-6400",
            "fax_number": "417-347-6404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3202 MCINTOSH CIR",
            "address_2": "SUITE LL03",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648043646",
            "telephone_number": "417-347-6400",
            "fax_number": "417-347-6404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENDICOTT",
        "first_name": "JILL",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-03",
        "last_updated": "2015-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2004019593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "192713",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00175249",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200034570A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200265670A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "429313307",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abdulla Elsayadh
• Elsten Enterprises Inc
• Emily Katherine Handley, DDS, PC
• Cory Bryant Emmert, DO
• Sheree Dawn Emmert, NP
• Randy A. Engelman, DO
• Jessica Renee Engle, WHNP
• Carolyn V. English-Levis, D.C.
• John Edward Enneking
• Don Dewayne Enyart, CRNA

• Nurse Practitioner in Joplin, MO
• Providers in Joplin, MO by specialty
• Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2015; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.