Jennifer Lynn Douglas, CPM, LM

Primary specialty

MidwifeTaxonomy code 176B00000X

License

1070081441 Issued in VT

Practice address

830 East Rd.
Clarksburg, MA 01247

Phone

(845) 264-8724

Fax

(888) 224-1413

NPI assigned

Oct 21, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Jennifer Lynn Rush Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1319155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677628800000",
    "number": "1487930442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 EAST RD.",
            "city": "CLARKSBURG",
            "state": "MA",
            "postal_code": "01247",
            "telephone_number": "845-264-8724",
            "fax_number": "888-224-1413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 EAST RD.",
            "city": "CLARKSBURG",
            "state": "MA",
            "postal_code": "01247",
            "telephone_number": "845-264-8724",
            "fax_number": "888-224-1413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "CPM, LM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-21",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "VT",
            "license": "107.0081441",
            "primary": false
        },
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "VT",
            "license": "1070081441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "RUSH",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Clarksburg School District
• Eric James Denette, BCBA
• Danielle Galietti
• Jamie Saunders
• Makenzie Ladd Suters
• Jamie L Tooley

• All providers in Clarksburg, MA
• Midwife in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; 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.