Jacqueline Dawn Fochtmann, RN

Primary specialty

General Practice Registered NurseTaxonomy code 163WG0000X

License

1-114223 Issued in AL

Practice address

208 Pierson Ave
Centreville, AL 35042-2918

Phone

(205) 926-3288

NPI assigned

Nov 29, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

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

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Bibb County Healthcare AuthorityGroup PAC ID 7113822883, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

Practice roles

Locations

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.

• The Bibb County Healthcare Authority

  • Rural Health Clinic/Center
  • Centreville, AL
  • NPI 1972532299
  Medicare reassignment Care Compare group NPD
• The Bibb County Health Care Authority

  • Pharmacy
  • Centreville, AL
  • NPI 1568558146
  NPD

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

{
    "created_epoch": "1638144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1699433433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5885 HIGHWAY 82",
            "city": "CENTREVILLE",
            "state": "AL",
            "postal_code": "350425713",
            "telephone_number": "205-337-3949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 PIERSON AVE",
            "city": "CENTREVILLE",
            "state": "AL",
            "postal_code": "350422918",
            "telephone_number": "205-926-3288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOCHTMANN",
        "first_name": "JACQUELINE",
        "middle_name": "DAWN",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-29",
        "last_updated": "2021-11-29",
        "certification_date": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "AL",
            "license": "1-114223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lloyd Ray Dunn II, CRNA
• Joshua Elledge, CRNP
• Sydney Ellison, DO
• Julia Cecile Fibbe
• Danielle Effre Fillingame, LPC
• Watson David Floyd Fondren, DC
• Amelia Foster, R.D.
• Meredith Schuckert Fowler
• Kiandrea Futrell, LICSW
• Lena Jeanelle Gamble, MD, PHD

• General Practice Registered Nurse in Centreville, AL
• Providers in Centreville, AL by specialty
• General Practice Registered Nurse in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.