Individual provider Active NPI

Jessilynn Reese Rose, MD

  • Emergency Medicine Physician
  • Anderson, IN
National Provider Identifier
1336403070
Registry record updated Mar 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
01075326A Issued in IN
Practice address
2015 Jackson St
Anderson, IN 46016-4337
Phone
(765) 609-6060
NPI assigned
Jun 27, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 4301101508 MI
Emergency Medicine Physician 207P00000X 01075326A IN Primary

Addresses

Primary practice location

2015 Jackson St
Anderson, IN 46016-4337

Mailing address

250 W 96TH St # 520
Indianapolis, IN 46260-1316

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150626000913 IN Practitioner - Emergency Medicine 2264664135 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
70.94
Improvement activities
40
Cost
92.94

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301101508MIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America LLC Emergency Medicine CurrentSince Jul 1, 2022 Accepting new patients
Cep America LLC Emergency Medicine CurrentSince Jul 1, 2022 Accepting new patients
Riverview Hospital CurrentSince Nov 4, 2019 Accepting new patients
Cep America LLC Emergency Medicine Current Accepting new patients
Riverview Hospital Emergency Medicine CurrentSince Nov 4, 2019 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

2015 Jackson St
Anderson, IN 46016
Phone (765) 646-8243

14585 Hazel Dell Pkwy
Rm Urgent
Carmel, IN 46033
Phone (317) 214-5030

1331 S A St
Elwood, IN 46036
Phone (765) 552-4000

395 Westfield Rd
Noblesville, IN 46060
Phone (317) 218-3136

865 Westfield Rd
Noblesville, IN 46062
Phone (317) 770-1700

1606 N 7th St
Terre Haute, IN 47804
Phone (812) 238-7523

Organizations & group practices 5

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": "1340755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552953600000",
    "number": "1336403070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 W 96TH ST # 520",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462601316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 JACKSON ST",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460164337",
            "telephone_number": "765-609-6060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "JESSILYNN",
        "middle_name": "REESE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-27",
        "last_updated": "2019-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301101508",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01075326A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anderson, IN

Sources for this page

Verify at the official NPI Registry.