Individual provider Active NPI

Jamie Fauth, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Rochester, NY
National Provider Identifier
1396098455
Registry record updated Sep 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95002650 Issued in CA
Practice address
100 Pinewild Dr Ste 2a
Rochester, NY 14606-4200
Phone
(585) 368-6700
Fax
(585) 368-6767
NPI assigned
Oct 25, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95002650 CA Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 402897 NY
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP124349 TX

Addresses

Primary practice location

100 Pinewild Dr Ste 2a
Rochester, NY 14606-4200

Mailing address

100 Kings Hwy S
Rochester, NY 14617-5504
Phone (585) 368-6700

Other identifiers 1

IdentifierTypeStateIssuer
325599402MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
402897NYMDPsychiatric/Mental Health Nurse Practitioner
95002650CAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
The Unity Hospital of Rochester CurrentSince Jan 20, 2020 Accepting new patients
The Unity Hospital of Rochester Current Accepting new patients

Locations

81 Lake Ave
Rochester, NY 14608
Phone (585) 368-6900

100 Pinewild Dr
#2A
Rochester, NY 14606
Phone (585) 368-6700

100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553

1555 Long Pond Rd
Rochester, NY 14626
Phone (585) 429-2289

Organizations & group practices 2

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": "1351123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1396098455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 KINGS HWY S",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146175504",
            "telephone_number": "585-368-6700",
            "fax_number": "585-368-6767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PINEWILD DR STE 2A",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146064200",
            "telephone_number": "585-368-6700",
            "fax_number": "585-368-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAUTH",
        "first_name": "JAMIE",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-25",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95002650",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "402897",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "AP124349",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "325599402",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.