Jamie C Mathis, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

1-177567 Issued in AL

Practice address

4412 Hogan Rd
Deatsville, AL 36022-3400

Phone

(334) 543-4851

Fax

(833) 434-1412

NPI assigned

Aug 19, 2019

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

Medicare fee-for-service enrollment

Enrolled in AL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Children'S Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Birmingham, AL
  • NPI 1124541438

  AL

  Medicare reassignment NPD
• Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Hayneville, AL
  • NPI 1598788218

  AL

  Medicare reassignment NPD
• Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Montgomery, AL
  • NPI 1538181490
  NPD
• Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Montgomery, AL
  • NPI 1184284986
  NPD
• Ivy Creek of Elmore, LLC

  • Surgery Physician
  • Wetumpka, AL
  • NPI 1154642684
  NPD (past)
• Ivycreek of Elmore LLC

  • Rural Health Clinic/Center
  • Wetumpka, AL
  • NPI 1396066650
  NPD (past)
• Magnolia Commons Pediatrics LLC

  • Pediatric Adolescent Medicine Physician
  • Wetumpka, AL
  • NPI 1013280486
  NPD (past)
• Montgomery Pediatric Assoc, P.a.

  • Pediatric Adolescent Medicine Physician
  • Montgomery, AL
  • NPI 1770532681
  NPD (past)
• Wetumpka Urgent Care LLC

  • Urgent Care Clinic/Center
  • Wetumpka, AL
  • NPI 1194057554
  NPD (past)

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

{
    "created_epoch": "1566172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1346897907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4412 HOGAN RD",
            "city": "DEATSVILLE",
            "state": "AL",
            "postal_code": "360223400",
            "telephone_number": "334-543-4851",
            "fax_number": "833-484-1412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4412 HOGAN RD",
            "city": "DEATSVILLE",
            "state": "AL",
            "postal_code": "360223400",
            "telephone_number": "334-543-4851",
            "fax_number": "833-434-1412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "JAMIE",
        "middle_name": "C",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-19",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AL",
            "license": "1-177567",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ivy Creek of Elmore, LLC
• Jackson Hospital and Clinic, Inc
• Susie Bernice Jackson
• Lake Pharmacy LLC
• Jennifer Hagan Mann, CRNP
• Donald Francis McArthur, PA-C
• John Cameron McCormick
• Angela C Mims, RN CDCES
• Montgomery Drug Company Inc
• Jacey P Morgan, M.S., CCC-SLP

• All providers in Deatsville, AL
• Pediatric Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.