NPIMap

Individual provider Active NPI

Jennifer Ann Rose, CRNP

  • Primary Care Nurse Practitioner
  • Muscle Shoals, AL
National Provider Identifier
1720754674
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
1-155978 Issued in AL
Practice address
2410 Avalon Ave
Muscle Shoals, AL 35661-3283
Phone
(256) 386-0808
Fax
(256) 389-8904
NPI assigned
Aug 20, 2021
Last updated
May 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 1-155978 AL Primary
Licensed Practical Nurse 164W00000X 1-155978 AL

Addresses

Primary practice location

2410 Avalon Ave
Muscle Shoals, AL 35661-3283

Mailing address

2410 Avalon Ave
Muscle Shoals, AL 35661-3283
Phone (256) 386-0808

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220114002249 AL Practitioner - Nurse Practitioner 2163814575 Reassigns benefits to 2 organizations
I20241104004076 TX Practitioner - Nurse Practitioner 2163814575 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shannon ClinicGroup PAC ID 0840103727, 550 clinicians
The West Texas Rehabilitation CenterGroup PAC ID 2860301215, shared by 5 NPIs, 444 clinicians

Practice addresses (Care Compare)

3016 Vista del Arroyo Dr
San Angelo, TX 76904-6146
Phone (325) 747-2004

4601 Hartford St
Abilene, TX 79605-4603
Phone (325) 793-3411

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.63 of 100Reported as group
Quality
78.21
Promoting interoperability
96
Improvement activities
40
Cost
67.22

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Avalon Medical Group CurrentSince Mar 17, 2024 Accepting new patients
Signify Health, LLC CurrentSince Dec 1, 2021 Accepting new patients
Avalon Medical Group CurrentSince Jun 23, 2023 Accepting new patients
Shannon Clinic CurrentSince Oct 1, 2024 Accepting new patients
Southern Dermatology Center, PC PastSince Nov 1, 2021 Accepting new patients
Florence Family Practice PastSince Nov 1, 2021 Accepting new patients

Locations

4000 Eagle Point Corporate Dr
Birmingham, AL 35242
Phone (205) 317-0280

2410 Avalon Ave
Muscle Shoals, AL 35661
Phone (256) 386-0808

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

120 E Beauregard Ave
San Angelo, TX 76903
Phone (915) 658-1511

3016 Vista del Arroyo Dr
San Angelo, TX 76904
Phone (325) 747-2004

Interoperability endpoints

  • Direct secure messaging: jrose70305@shannonhealth.direct-ci.com

Organizations & group practices 6

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 6

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": "1629417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715817600000",
    "number": "1720754674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2410 AVALON AVE",
            "city": "MUSCLE SHOALS",
            "state": "AL",
            "postal_code": "356613283",
            "telephone_number": "256-386-0808",
            "fax_number": "256-389-8904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 AVALON AVE",
            "city": "MUSCLE SHOALS",
            "state": "AL",
            "postal_code": "356613283",
            "telephone_number": "256-386-0808",
            "fax_number": "256-389-8904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-20",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "AL",
            "license": "1-155978",
            "primary": true
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AL",
            "license": "1-155978",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muscle Shoals, AL

Sources for this page

Verify at the official NPI Registry.