NPIMap

Individual provider Active NPI

Jessica Elizabeth Smith, FNP

  • Family Nurse Practitioner
  • Shreveport, LA
National Provider Identifier
1699081620
Registry record updated May 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP06271 Issued in LA
Practice address
1455 E Bert Kouns Industrial Loop # 300
Shreveport, LA 71105-6000
Phone
(318) 798-4488
Fax
(318) 798-4431
NPI assigned
Aug 27, 2010
Last updated
May 28, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2019

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 AP06271 LA Primary

Addresses

Primary practice location

1455 E Bert Kouns Industrial Loop # 300
Shreveport, LA 71105-6000

Mailing address

PO Box 415000 LBX 410604
Nashville, TN 37241-0604
Phone (318) 798-4539

Other identifiers 1

IdentifierTypeStateIssuer
2121031MedicaidLA

Other names 1

  • Jessica Elizabeth Wise Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101020000271 LA Practitioner - Nurse Practitioner 9537352794 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Highland Clinic, a Prof Med CorpGroup PAC ID 3870493463, 60 clinicians
Cornerstone Therapy and Balance Center, LLCGroup PAC ID 0345397899, 98 clinicians

Practice addresses (Care Compare)

1455 E Bert Koun Loop
Shreveport, LA 71105-5634
Phone (318) 798-4539

8961 Youree Dr
Shreveport, LA 71115-3001
Phone (318) 671-8772

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.6 of 100Reported as group
Quality
58.23
Promoting interoperability
97
Improvement activities
40
Cost
72.94

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP06271LAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Highland Clinic, a Prof Med Corp CurrentSince May 1, 2018 Accepting new patients
Highland Clinic, a Prof Med Corp CurrentSince May 1, 2018 Accepting new patients
Highland Clinic Optical Shop, LLC Past Accepting new patients

Locations

1455 E Bert Kouns Industrial Loop
Shreveport, LA 71105
Phone (318) 300-3643

1455 E Bert Kouns Industrial Loop
#300
Shreveport, LA 71105
Phone (318) 798-4488

1455 E Bert Kouns Industrial Loop
Ste 300
Shreveport, LA 71105
Phone (318) 798-4488

Interoperability endpoints

  • Direct secure messaging: jessica.smith.p1@direct.hcapmc.nextgenshare.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1282867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559001600000",
    "number": "1699081620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415000 LBX 410604",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372410604",
            "telephone_number": "318-798-4539",
            "fax_number": "318-798-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 E BERT KOUNS INDUSTRIAL LOOP # 300",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711056000",
            "telephone_number": "318-798-4488",
            "fax_number": "318-798-4431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JESSICA",
        "middle_name": "ELIZABETH",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-27",
        "last_updated": "2019-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "AP06271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2121031",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "WISE",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.