Active NPI
Jennifer Klotz Jubulis, MD
- Pediatric Infectious Diseases Physician
- Portland, ME
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Infectious Diseases Physician
- License
- MD19415
- Practice address
- 887 Congress St
Suite 320
Portland, ME 04102 - Phone
- (207) 662-5522
- Fax
- (207) 662-5527
- NPI assigned
- Mar 1, 2007
- Last updated
- Oct 8, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | D0068961 | MD | |
| Pediatrics Physician | 208000000X | MD19415 | ME | |
| Pediatric Infectious Diseases Physician | 2080P0208X | MD19415 | ME | Primary |
Addresses
Primary practice location
887 Congress St
Suite 320
Portland, ME 04102
Mailing address
301C US Route One
Scarborough, ME 04074
Phone (207) 396-8600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 332504100 | Medicaid | MD |
Other names 1
- Jennifer Klotz
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mainehealth | Current | Accepting new patients | |
| Maine Medical Partners | Pediatrics | Current | Accepting new patients |
| Maine Medical Partners | Current | Accepting new patients | |
| Mainehealth | Current | Accepting new patients | |
| Mainehealth | Current | Accepting new patients | |
| Maine Medical Partners | Pediatric Infectious Diseases | Current | Accepting new patients |
| Mainehealth | Pediatrics | Past | Accepting new patients |
Locations
22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179
887 Congress St
Ste 320
Portland, ME 04102
Phone (207) 662-5522
301C US Route 1
Scarborough, ME 04074
Phone (207) 396-8600
1 Harnois Ave
Ste 1A
Westbrook, ME 04092
Phone (207) 662-1360
Interoperability endpoints
- jjubulis18462@direct.mmc.mainehealth.org
Organizations & group practices 7
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.
-
dba Maine Medical Partners Pediatrics
- Pediatrics Physician
- Saco, ME
- NPI 1134144090
-
- Surgery Physician
- Scarborough, ME
- NPI 1346687167
-
dba Maine Medical Partners Pediatric Specialty Care
- Pediatric Gastroenterology Physician
- Portland, ME
- NPI 1992719272
Pediatric Infectious Diseases
-
dba MaineHealth Pharmacy Brighton Ave
- Community/Retail Pharmacy
- Portland, ME
- NPI 1013868181
-
dba Maine Medical Partners Otolaryngology
- Otolaryngology Physician
- Portland, ME
- NPI 1649577768
-
dba MaineHealth Medical Group-Primary Care
- Clinic/Center
- Portland, ME
- NPI 1487346722
Pediatrics
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349654400000",
"number": "1457489742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301C US ROUTE ONE",
"city": "SCARBOROUGH",
"state": "ME",
"postal_code": "04074",
"telephone_number": "207-396-8600",
"fax_number": "207-396-8632"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "887 CONGRESS ST",
"address_2": "SUITE 320",
"city": "PORTLAND",
"state": "ME",
"postal_code": "04102",
"telephone_number": "207-662-5522",
"fax_number": "207-662-5527"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUBULIS",
"first_name": "JENNIFER",
"middle_name": "KLOTZ",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-01",
"last_updated": "2012-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MD",
"license": "D0068961",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "ME",
"license": "MD19415",
"primary": false
},
{
"code": "2080P0208X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Infectious Diseases",
"state": "ME",
"license": "MD19415",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "332504100",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "KLOTZ",
"credential": "MD",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2012; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.