Jessica Bacon, FNP
Individual provider Active NPI Family Nurse Practitioner · Hilton Head, SC
NPI 1407449663 · NPPES record last updated Feb 18, 2022
Key facts
- NPI
- 1407449663
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 24873 (SC)
- Practice address
- 10 Pope Ave # 5566
Hilton Head, SC 29928-4719 - Phone
- (843) 785-7786
- NPI assigned
- Feb 18, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Primary Care PLLC
Minuteclinic LLC
Practice addresses (Care Compare)
150 Johnny Mercer Blvd
Savannah, GA 31410-2102
Phone (866) 389-2727
5401 Abercorn St
Savannah, GA 31405-6901
Phone (866) 389-2727
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SC, GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210921003816 | SC | Practitioner - Nurse Practitioner | 1658778477 | Reassigns benefits to 1 organization |
| I20220315001962 | GA | Practitioner - Nurse Practitioner | 1658778477 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN292014 | GA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Minuteclinic LLC | Family | Current |
Accepting new patients |
| Primary Care PLLC | Family | Current |
Accepting new patients |
| Minuteclinic Primary Care South Carolina LLC | Family | Current |
Accepting new patients |
| South Carolina CVS Pharmacy LLC | Past |
Accepting new patients |
Locations
11710 Alpharetta Hwy
Roswell, GA 30076
Phone (770) 754-0141
150 Johnny Mercer Blvd
Savannah, GA 31410
Phone (912) 897-0094
5401 Abercorn St
Savannah, GA 31405
Phone (912) 356-3170
7207 Rockbridge Rd
Stone Mtn, GA 30087
Phone (770) 469-2002
10 Pope Ave
#5566
Hilton Head Island, SC 29928
Phone (843) 785-7786
10 Pope Ave
Hilton Head Island, SC 29928
Phone (843) 785-7786
8995 University Blvd
North Charleston, SC 29406
Phone (843) 410-0701
698 Fairview Rd
Simpsonville, SC 29680
Phone (864) 962-8991
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN292014 | GA | |
| Family Nurse Practitioner | 363LF0000X | 24873 | SC | Yes |
Addresses
Primary practice location
10 Pope Ave # 5566
Hilton Head, SC 29928-4719
Mailing address
10 Pope Ave # 5566
Hilton Head, SC 29928-4719
Phone (843) 785-7786
Other practice location 1
5401 Abercorn St
Savannah, GA 31405-6901
Phone (866) 389-2727
Other providers in Hilton Head, SC
- Gabrielle Kay Amos
- Tammy Anderson
- Atlantic Radiology Associates
- Atlantic Radiology Associates LLC
- Atlantic Radiology Associates LLC
- Ravina Balchandani
- Alina Balshem
- Hannah Louise Bannon
- Beaufort County Allergy
- Becky Peters Counseling, LLC
All providers in Hilton Head, SC · Family Nurse Practitioner in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.