Jessica Bacon, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

24873 Issued in SC

Practice address

10 Pope Ave # 5566
Hilton Head, SC 29928-4719

Phone

(843) 785-7786

NPI assigned

Feb 18, 2021

Last updated

Feb 18, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC, GA2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Primary Care PLLCGroup PAC ID 0941642169, 19 clinicians

Minuteclinic LLCGroup PAC ID 6709850241, 576 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Minuteclinic LLC

  • Family Nurse Practitioner
  • Rockville, MD
  • NPI 1134191836

  GA

  Medicare reassignment Care Compare group NPD
• Primary Care PLLC

  • Family Nurse Practitioner
  • Spring, TX
  • NPI 1770354763

  GA

  Medicare reassignment Care Compare group NPD
• Minuteclinic Primary Care South Carolina LLC

  • Family Nurse Practitioner
  • Simpsonville, SC
  • NPI 1548070071
  Medicare reassignment NPD
• South Carolina CVS Pharmacy LLC

  dba CVS Pharmacy #17932

  • Pharmacy
  • Indian Land, SC
  • NPI 1174406573
  NPD (past)

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

{
    "created_epoch": "1613606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645142400000",
    "number": "1407449663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 POPE AVE # 5566",
            "city": "HILTON HEAD",
            "state": "SC",
            "postal_code": "299284719",
            "telephone_number": "843-785-7786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 POPE AVE # 5566",
            "city": "HILTON HEAD",
            "state": "SC",
            "postal_code": "299284719",
            "telephone_number": "843-785-7786"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5401 Abercorn St",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314056901",
            "country_code": "US",
            "telephone_number": "866-389-2727",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BACON",
        "first_name": "JESSICA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-18",
        "last_updated": "2022-02-18",
        "certification_date": "2022-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN292014",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "24873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabrielle Kay Amos
• Tammy Anderson, DOM
• Atlantic Radiology Associates (Advanced Medical Imaging)
• Atlantic Radiology Associates LLC
• Atlantic Radiology Associates LLC
• Ravina Balchandani, MD
• Alina Balshem, OT
• Hannah Louise Bannon, AU.D.
• Beaufort County Allergy (Allergy & Asthma Center of Hilton Head)
• Becky Peters Counseling, LLC

• Family Nurse Practitioner in Hilton Head, SC
• Providers in Hilton Head, SC by specialty
• Family Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.