Individual provider Active NPI

Rachael N. Jefferson, NP-C

  • Nurse Practitioner
  • Valdosta, GA
National Provider Identifier
1447766738
Registry record updated Dec 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN220323 Issued in GA
Practice address
4274 N Valdosta Rd
Valdosta, GA 31602-6814
Phone
(229) 242-1234
Fax
(229) 242-0687
NPI assigned
Dec 21, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN220323 GA
Nurse Practitioner 363L00000X RN220323 GA Primary
Registered Nurse 163W00000X RN220323 GA

Addresses

Primary practice location

4274 N Valdosta Rd
Valdosta, GA 31602-6814

Mailing address

1909 US Highway 82 W Ste 5
Tifton, GA 31793-8213
Phone (229) 386-4300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20200128001859 GA Practitioner - Nurse Practitioner 0840626545 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
SGMC Physician Network IncGroup PAC ID 4082036843, 128 clinicians

Practice addresses (Care Compare)

4274 N Valdosta Rd
Valdosta, GA 31602-6814
Phone (229) 242-1234

Hospital & facility affiliations

  • SGMC Health Hospital, Valdosta, GA, CCN 110122

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN220323GAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
SGMC Affiliated Services LLC Current Accepting new patients
SGMC Physician Network Inc CurrentSince Dec 3, 2023 Accepting new patients

Locations

4280 N Valdosta Rd
Valdosta, GA 31602
Phone (229) 433-7350

2501 N Patterson St
Valdosta, GA 31602
Phone (229) 259-4139

4274 N Valdosta Rd
Valdosta, GA 31602
Phone (229) 242-1234

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1513814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1447766738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1909 US HIGHWAY 82 W STE 5",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317938213",
            "telephone_number": "229-386-4300",
            "fax_number": "229-386-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4274 N VALDOSTA RD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316026814",
            "telephone_number": "229-242-1234",
            "fax_number": "229-242-0687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEFFERSON",
        "first_name": "RACHAEL",
        "middle_name": "N.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-21",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN220323",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN220323",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN220323",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

Verify at the official NPI Registry.