Active NPI
Jessica Marie Jurcak, MS, MPH, RD LD
- Registered Dietitian
- Lakewood, OH
National Provider Identifier
1467929125
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD.08277
- Practice address
- 17317 Madison Ave Apt 21
Lakewood, OH 44107-3565 - Phone
- (440) 865-1266
- NPI assigned
- Oct 30, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | LD.08277 | OH | Primary |
Addresses
Primary practice location
17317 Madison Ave Apt 21
Lakewood, OH 44107-3565
Mailing address
17317 Madison Ave Apt 21
Lakewood, OH 44107-3565
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD.08277 | OH | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| On the Move Nutrition | Dietitian, Registered | Current | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544054400000",
"number": "1467929125",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17317 MADISON AVE APT 21",
"city": "LAKEWOOD",
"state": "OH",
"postal_code": "441073565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17317 MADISON AVE APT 21",
"city": "LAKEWOOD",
"state": "OH",
"postal_code": "441073565",
"telephone_number": "440-865-1266"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JURCAK",
"first_name": "JESSICA",
"middle_name": "MARIE",
"credential": "MS, MPH, RD LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-30",
"last_updated": "2018-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OH",
"license": "LD.08277",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.