Individual provider Active NPI

Jessica Taibl, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Beachwood, OH
National Provider Identifier
1437747185
Registry record updated Apr 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APRN.CNP.0028687 Issued in OH
Practice address
23425 Commerce Park Ste 104
Beachwood, OH 44122-5848
Phone
(216) 831-2900
NPI assigned
Jan 7, 2021
Last updated
Apr 9, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRN.CNP.0028687 OH Primary
Registered Nurse 163W00000X RN.465268 OH

Addresses

Primary practice location

23425 Commerce Park Ste 104
Beachwood, OH 44122-5848

Mailing address

23425 Commerce Park Ste 104
Beachwood, OH 44122-5848
Phone (216) 831-2900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20210830003090 OH Practitioner - Nurse Practitioner 2365848363 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Debalzo, Elgudin. Levine, Risen LLCGroup PAC ID 3072880715, 10 clinicians

Practice addresses (Care Compare)

23425 Commerce Park
Suite 104
Beachwood, OH 44122-5848
Phone (216) 831-2900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN.465268OHMDRegistered Nurse
APRN.CNP.0028687OHMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Debalzo Elgudin Levine Risen LLC CurrentSince Aug 17, 2021 Accepting new patients

Locations

23425 Commerce Park
Ste 104
Beachwood, OH 44122
Phone (216) 831-2900

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1609977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617926400000",
    "number": "1437747185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23425 COMMERCE PARK STE 104",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225848",
            "telephone_number": "216-831-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23425 COMMERCE PARK STE 104",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225848",
            "telephone_number": "216-831-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAIBL",
        "first_name": "JESSICA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-07",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRN.CNP.0028687",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.465268",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beachwood, OH

Sources for this page

Verify at the official NPI Registry.