NPIMap

Individual provider Active NPI

Jennifer Blaylock, FNP

  • Primary Care Nurse Practitioner
  • Polk City, IA
National Provider Identifier
1316651524
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
A172505 Issued in IA
Practice address
1010 S 3Rd St
Polk City, IA 50226-1130
Phone
(515) 986-6426
NPI assigned
Jan 11, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 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 A172505 IA
Primary Care Nurse Practitioner 363LP2300X A172505 IA Primary

Addresses

Primary practice location

1010 S 3Rd St
Polk City, IA 50226-1130

Mailing address

15196 NW 16TH St
Slater, IA 50244-8019
Phone (515) 619-1475

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231205002357 IA Practitioner - Nurse Practitioner 9638528425 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Douglas a Layton DOGroup PAC ID 8325495294, 2 clinicians
On With Life IncGroup PAC ID 4385553965, 8 clinicians

Practice addresses (Care Compare)

1010 S 3Rd St
1A North Polk Family Medicine
Polk City, IA 50226-1165
Phone (515) 984-6426

717 SW Ankeny Rd
Ankeny, IA 50023-9798
Phone (515) 289-9600

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Douglas a Layton DO, PLLC CurrentSince Oct 30, 2023 Accepting new patients
Douglas a Layton DO CurrentSince Oct 30, 2023 Accepting new patients
On With Life, Inc CurrentSince Feb 2, 2024 Accepting new patients
On With Life, Inc. CurrentSince Feb 2, 2024 Accepting new patients

Locations

715 SW Ankeny Rd
Ankeny, IA 50023
Phone (515) 289-9600

717 SW Ankeny Rd
Ankeny, IA 50023
Phone (515) 289-9600

1010 S 3rd St
Polk City, IA 50226
Phone (515) 984-6426

1002 W Washington Ave
Polk City, IA 50226
Phone (515) 984-6411

1010 S 3rd St
Ste 1A
Polk City, IA 50226
Phone (515) 984-6426

Interoperability endpoints

  • Direct secure messaging: jblaylock@owl-ankeny-outpatient.direct.kno2fy.com
  • Direct secure messaging: jennifer.blaylock@owli-ia.direct.office.nextgen.com
  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1673395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1316651524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15196 NW 16TH ST",
            "city": "SLATER",
            "state": "IA",
            "postal_code": "502448019",
            "telephone_number": "515-619-1475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 S 3RD ST",
            "city": "POLK CITY",
            "state": "IA",
            "postal_code": "502261130",
            "telephone_number": "515-986-6426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAYLOCK",
        "first_name": "JENNIFER",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-11",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IA",
            "license": "A172505",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IA",
            "license": "A172505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Polk City, IA

Sources for this page

Verify at the official NPI Registry.