Active NPI
Jacquelyn Courim, DNP
- Family Medicine Physician
- Russell, PA
National Provider Identifier
1497519292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- SPO27894
- Practice address
- 5607 Route 957
Russell, PA 16345-2033 - Phone
- (814) 593-0011
- Fax
- (814) 593-0012
- NPI assigned
- Feb 12, 2024
- Last updated
- Feb 12, 2024
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | SPO27894 | PA | Primary |
Addresses
Primary practice location
5607 Route 957
Russell, PA 16345-2033
Mailing address
5607 Route 957
Russell, PA 16345-2033
Phone (814) 593-0011
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
| License | State | Type | Specialty |
|---|---|---|---|
| SPO27894 | PA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707696000000",
"number": "1497519292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5607 ROUTE 957",
"city": "RUSSELL",
"state": "PA",
"postal_code": "163452033",
"telephone_number": "814-593-0011",
"fax_number": "814-593-0012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5607 ROUTE 957",
"city": "RUSSELL",
"state": "PA",
"postal_code": "163452033",
"telephone_number": "814-593-0011",
"fax_number": "814-593-0012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COURIM",
"first_name": "JACQUELYN",
"credential": "DNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-12",
"last_updated": "2024-02-12",
"certification_date": "2024-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "SPO27894",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Russell, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.