Individual provider Active NPI

Jennifer Michelle Barham, NP-C

  • Dermatology Physician
  • New York, NY
National Provider Identifier
1316245137
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
7770247 Issued in TN
Practice address
300 E 56TH St Apt 3C
New York, NY 10022-4135
Phone
(516) 210-5600
Fax
(917) 254-4419
NPI assigned
Mar 2, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 15635 TN
Dermatology Physician 207N00000X 7770247 TN Primary

Addresses

Primary practice location

300 E 56TH St Apt 3C
New York, NY 10022-4135

Mailing address

305 Appleberry Cir
Kingsport, TN 37663-3389
Phone (423) 502-2134

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, NM2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20110418000743 TN Practitioner - Nurse Practitioner 7810171774 Reassigns benefits to 1 organization
I20250218001594 NM Practitioner - Nurse Practitioner 7810171774 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
East Tennessee State University Quillen College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Presbyterian Healthcare ServicesGroup PAC ID 9234041708, 1,390 clinicians

Practice addresses (Care Compare)

2421 W 21St St
Suite B
Clovis, NM 88101-2006
Phone (575) 769-7577

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
80241NMMDDermatology Physician
7770247TNMDDermatology Physician
15635TNMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services CurrentSince Feb 1, 2025 Accepting new patients
Presbyterian Healthcare Services CurrentSince Feb 1, 2025 Accepting new patients
Dermatology Associates, P.C. Dermatology CurrentSince Jul 1, 2012 Accepting new patients
Taos Health Systems, Inc., Holy Cross Hospital Past Accepting new patients

Locations

2421 W 21st St
Ste B
Clovis, NM 88101
Phone (575) 742-7824

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

2300 W Stone Dr
Kingsport, TN 37660
Phone (423) 246-4961

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1299024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730937600000",
    "number": "1316245137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 APPLEBERRY CIR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376633389",
            "telephone_number": "423-502-2134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E 56TH ST APT 3C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100224135",
            "telephone_number": "516-210-5600",
            "fax_number": "917-254-4419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARHAM",
        "first_name": "JENNIFER",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-02",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "15635",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TN",
            "license": "7770247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.