Individual provider Active NPI

Jessica Jane Henderson, APRN

  • Acute Care Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1427554658
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
3011774 Issued in KY
Practice address
4001 Dutchmans LN
Louisville, KY 40207-4714
Phone
(502) 893-1000
NPI assigned
Apr 5, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 3011774 KY Primary
Nurse Practitioner 363L00000X 3011774 KY

Addresses

Primary practice location

4001 Dutchmans LN
Louisville, KY 40207-4714

Mailing address

PO Box 776351
Chicago, IL 60677-6351
Phone (502) 588-9490

Other practice location 1

110 Executive Park
Louisville, KY 40207
Phone (502) 896-1881

Other identifiers 4

IdentifierTypeStateIssuer
7100568880MedicaidKY
K244160-KOHMGOtherKYKY MEDICARE
300024397MedicaidIN
000001171998-KOHMGOtherKYANTHEM BC/BS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20180427001671 KY Practitioner - Nurse Practitioner 2769746791 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Medical Associates IncGroup PAC ID 7012811284, 1,368 clinicians

Practice addresses (Care Compare)

4001 Dutchmans LN
Louisville, KY 40207-4714
Phone (502) 893-1000

Merit-based Incentive Payment System (MIPS)

Final score
81.11 of 100Reported as group
Quality
63.34
Promoting interoperability
100
Improvement activities
40
Cost
73.68

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical Associates, Inc. Nurse Practitioner CurrentSince Aug 23, 2023 Accepting new patients
Community Medical Associates, Inc. Nurse Practitioner CurrentSince Aug 23, 2023 Accepting new patients
Community Medical Associates, Inc. Nurse Practitioner Current Accepting new patients
Community Medical Associates, Inc. Nurse Practitioner Past Accepting new patients

Locations

850 S 28th St
Louisville, KY 40211
Phone (502) 629-7650

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

Interoperability endpoints

  • Direct secure messaging: jhenderson75161@bhkydirect.com

Organizations & group practices 4

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": "1522886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1427554658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776351",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776351",
            "telephone_number": "502-588-9490",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 DUTCHMANS LN",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074714",
            "telephone_number": "502-893-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 Executive Park",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "40207",
            "country_code": "US",
            "telephone_number": "502-896-1881",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "JESSICA",
        "middle_name": "JANE",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-05",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "KY",
            "license": "3011774",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3011774",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100568880",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KY MEDICARE",
            "identifier": "K244160-KOHMG",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300024397",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "000001171998-KOHMG",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.