Jessie Entwistle
Individual provider Active NPI Emergency Medicine Physician · Portsmouth, OH
NPI 1629487665 · NPPES record last updated Sep 13, 2023
Key facts
- NPI
- 1629487665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 34.012445 (OH)
- Practice address
- 1805 27TH St
Portsmouth, OH 45662-2640 - Phone
- (740) 356-5000
- Fax
- (740) 356-6387
- NPI assigned
- Aug 4, 2014
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 21
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- Kansas City University of Med & Biosciences, College of Osteo Med, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cep America LLC
Practice addresses (Care Compare)
6420 Clayton Rd
Richmond Heights, MO 63117-1811
Phone (314) 768-8000
Hospital & facility affiliations
- SSM Health St Mary'S Hospital - St Louis
- Southern Ohio Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.3 of 100
- Quality
- 70.94
- Improvement activities
- 40
- Cost
- 92.94
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OH, MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170120001959 | OH | Practitioner - Emergency Medicine | 4789966052 | Reassigns benefits to 1 organization |
| I20230206001327 | MO | Practitioner - Emergency Medicine | 4789966052 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2020023514 | MO | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Epmg of Ohio Inc P a | Emergency Medicine | Current |
Accepting new patients |
| Cep America, LLC | Emergency Medicine | Current | Accepting new patients |
| Cep America LLC | Emergency Medicine | Current |
Accepting new patients |
| Cep America LLC | Emergency Medicine | Current |
Accepting new patients |
Locations
1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423
2000 Green Rd
Ste 300
Ann Arbor, MI 48105
Phone (313) 995-3764
1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000
10010 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 525-1328
6420 Clayton Rd
Saint Louis, MO 63117
Phone (314) 768-8442
1805 27th St
Portsmouth, OH 45662
Phone (740) 356-5000
Interoperability endpoints
- jessie.entwistle@somc.medicity.net
- jentwistle440250@direct-ehr-ssmhc.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 34.012445 | OH | Yes |
| Emergency Medicine Physician | 207P00000X | 2020023514 | MO |
Addresses
Primary practice location
1805 27TH St
Portsmouth, OH 45662-2640
Mailing address
1735 27TH St
Waller BLDG. Suite B 06
Portsmouth, OH 45662-2677
Phone (740) 356-6800
Other providers in Portsmouth, OH
- Stephanie Lea Emmons
- Empower Treatment LLC
- Empower Treatment LLC
- Jessica Erin English
- Cynthia Entler
- Latija Enyart
- Epmg of Ohio Inc P a
- Jaelyn Erny
- Roberta Ervin
- George Elwood Esham
All providers in Portsmouth, OH · Emergency Medicine Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.