Individual provider Active NPI

Jamiley C Maynard, FNP

  • Family Nurse Practitioner
  • Terre Haute, IN
National Provider Identifier
1689897886
Registry record updated Jul 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71001096A Issued in IN
Practice address
2723 S 7TH Street
Suite C
Terre Haute, IN 47802-3558
Phone
(812) 232-5936
Fax
(812) 235-1290
NPI assigned
Apr 10, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71001096A IN Primary

Addresses

Primary practice location

2723 S 7TH Street
Suite C
Terre Haute, IN 47802-3558

Mailing address

2723 S 7TH St
Suite a
Terre Haute, IN 47802-3558
Phone (812) 238-1730

Other identifiers 1

IdentifierTypeStateIssuer
200822620MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100416000731 IN Practitioner - Nurse Practitioner 0345377610 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Union Hospital IncGroup PAC ID 8426943614, 90 clinicians

Practice addresses (Care Compare)

2723 S 7TH St
Suite C
Terre Haute, IN 47802-3558
Phone (812) 232-5936

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Union Hospital, Inc. CurrentSince Aug 12, 2020 Accepting new patients
Providence Medical Group LLC CurrentSince Feb 1, 2010 Accepting new patients
Union Hospital, Inc. CurrentSince Aug 12, 2020 Accepting new patients
Union Hospital Inc. Past Accepting new patients

Locations

2723 S 7th St
Ste A
Terre Haute, IN 47802
Phone (812) 238-1730

1606 N 7th St
Terre Haute, IN 47804
Phone (812) 238-7523

2723 S 7th St
Ste L
Terre Haute, IN 47802
Phone (812) 232-0921

2723 S 7th St
Ste C
Terre Haute, IN 47802
Phone (812) 232-2936

Organizations & group practices 4

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405382400000",
    "number": "1689897886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2723 S 7TH ST",
            "address_2": "SUITE A",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478023558",
            "telephone_number": "812-238-1730",
            "fax_number": "812-242-1565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2723 S 7TH STREET",
            "address_2": "SUITE C",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478023558",
            "telephone_number": "812-232-5936",
            "fax_number": "812-235-1290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYNARD",
        "first_name": "JAMILEY",
        "middle_name": "C",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-10",
        "last_updated": "2014-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71001096A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200822620",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Terre Haute, IN

Sources for this page

Verify at the official NPI Registry.