NPIMap

Organization Active NPI

Saint Jude Medical Group LLC Home Doctors

  • Nurse Practitioner
  • Henderson, NV
National Provider Identifier
1730713611
Registry record updated Mar 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
SAINT JUDE MEDICAL GROUP LLC HOME DOCTORS
Practice address
871 Coronado Center Dr Ste 200
Henderson, NV 89052-3977
Phone
(702) 934-6441
Fax
(702) 933-1060
NPI assigned
Feb 28, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2026

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

Authorized official

Name
Nerissa Dimailig, APRN
Title
Owner
Phone
(725) 228-5186

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

871 Coronado Center Dr Ste 200
Henderson, NV 89052-3977

Mailing address

871 Coronado Center Dr Ste 200
Henderson, NV 89052-3977
Phone (725) 228-5186

Other names 1

  • HOME DOCTORS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200414003437 NV Part B Supplier - Clinic/Group Practice 4981034972 Receives reassigned benefits from 6 practitioners
Practice locations: Henderson, NV

National Provider Directory

National Provider Directory

Locations

4412 W Charleston Blvd
Ste B
Las Vegas, NV 89102
Phone (702) 382-7753

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1582848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773878400000",
    "number": "1730713611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "871 CORONADO CENTER DR STE 200",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890523977",
            "telephone_number": "725-228-5186",
            "fax_number": "702-933-1060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "871 CORONADO CENTER DR STE 200",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890523977",
            "telephone_number": "702-934-6441",
            "fax_number": "702-933-1060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT JUDE MEDICAL GROUP LLC HOME DOCTORS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-28",
        "last_updated": "2026-03-19",
        "certification_date": "2026-03-19",
        "status": "A",
        "authorized_official_last_name": "DIMAILIG",
        "authorized_official_first_name": "NERISSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "725-228-5186",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HOME DOCTORS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HOME DOCTORS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.