Individual provider Active NPI

Jill Marie Rough, CRNP

  • Family Nurse Practitioner
  • Erie, PA
National Provider Identifier
1457502098
Registry record updated Oct 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP009082 Issued in PA
Practice address
232 W 25TH St
Erie, PA 16544-0002
Phone
(814) 452-5000
NPI assigned
Oct 1, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2008

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN278183L PA
Registered Nurse 163W00000X 382899-1 NY
Family Nurse Practitioner 363LF0000X SP009082 PA Primary
Family Nurse Practitioner 363LF0000X F335103-1 NY

Addresses

Primary practice location

232 W 25TH St
Erie, PA 16544-0002

Mailing address

232 W 25TH St
Erie, PA 16544-0002
Phone (814) 452-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
382899-1NYMDRegistered Nurse
RN278183LPAMDRegistered Nurse
F335103-1NYMDFamily Nurse Practitioner
SP009082PAMDFamily Nurse Practitioner

Interoperability endpoints

  • Direct secure messaging: jrough154424@direct.ahn.org

NPI Registry JSON

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

{
    "created_epoch": "1222819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222819200000",
    "number": "1457502098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 W 25TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165440002",
            "telephone_number": "814-452-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 W 25TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165440002",
            "telephone_number": "814-452-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUGH",
        "first_name": "JILL",
        "middle_name": "MARIE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-01",
        "last_updated": "2008-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN278183L",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "382899-1",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP009082",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F335103-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.