Individual provider Active NPI

Jessica Smith, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Lorain, OH
National Provider Identifier
1336673425
Registry record updated Jun 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APRN.CNP.024899 Issued in OH
Practice address
6140 S Broadway
Lorain, OH 44053-3891
Phone
(440) 204-4315
Fax
(440) 204-4315
NPI assigned
Apr 14, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN.396336 OH
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRN.CNP.024899 OH Primary

Addresses

Primary practice location

6140 S Broadway
Lorain, OH 44053-3891

Mailing address

6140 S Broadway
Lorain, OH 44053-3891
Phone (440) 204-4315

Other names 1

  • Jessica Herron Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20190807002502 OH Practitioner - Nurse Practitioner 7719214188 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

6140 S Broadway
Lorain, OH 44053-3821
Phone (440) 233-7232

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN.396336OHMDRegistered Nurse
APRN.CNP.024899OHMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Riveon Mental Health and Recovery CurrentSince Jun 24, 2019 Accepting new patients
Riveon Mental Health and Recovery Current Accepting new patients
Riveon Mental Health and Recovery CurrentSince Jun 24, 2019 Accepting new patients

Locations

6140 S Broadway
Lorain, OH 44053
Phone (440) 233-7232

Organizations & group practices 3

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": "1492128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1336673425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6140 S BROADWAY",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440533891",
            "telephone_number": "440-204-4315",
            "fax_number": "440-204-4315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6140 S BROADWAY",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440533891",
            "telephone_number": "440-204-4315",
            "fax_number": "440-204-4315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JESSICA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-14",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.396336",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRN.CNP.024899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "HERRON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lorain, OH

Sources for this page

Verify at the official NPI Registry.