Individual provider Active NPI

Jennifer Anne O'Brien

  • Psychiatric/Mental Health Nurse Practitioner
  • Marlton, NJ
National Provider Identifier
1770125833
Registry record updated Aug 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
F402654-01 Issued in NY
Practice address
765 Route 70 E BLDG a-100
Marlton, NJ 08053-2341
Phone
(856) 983-3900
Fax
(856) 797-4785
NPI assigned
Oct 10, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F402654-01 NY Primary

Addresses

Primary practice location

765 Route 70 E BLDG a-100
Marlton, NJ 08053-2341

Mailing address

159 Carleton Ave
Central Islip, NY 11722-4172
Phone (631) 650-2087

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address credentialing@cfgpc.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20200918002357 NY Practitioner - Nurse Practitioner 9335576172 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
402654NYMDRegistered Nurse
F402654-01NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Long Island Select Healthcare, Inc. CurrentSince Jul 27, 2020 Accepting new patients
Long Island Select Healthcare, Inc. CurrentSince Jul 27, 2020 Accepting new patients
Center for Family Guidance, PC Past Accepting new patients
Center for Family Guidance PC PastSince Oct 13, 2019 Accepting new patients
Inpathy Behavioral Healthcare Group LLC PastSince Oct 13, 2019 Accepting new patients

Locations

159 Carleton Ave
Central Islip, NY 11722
Phone (631) 439-4300

120 Plant Ave
Hauppauge, NY 11788
Phone (631) 273-1300

883 E Main St
Riverhead, NY 11901
Phone (631) 284-5500

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CCJFAD

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1570665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597363200000",
    "number": "1770125833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 CARLETON AVE",
            "city": "CENTRAL ISLIP",
            "state": "NY",
            "postal_code": "117224172",
            "telephone_number": "631-650-2087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "765 ROUTE 70 E BLDG A-100",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080532341",
            "telephone_number": "856-983-3900",
            "fax_number": "856-797-4785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "JENNIFER",
        "middle_name": "ANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-10",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F402654-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "credentialing@cfgpc.com",
            "affiliation": "N",
            "address_1": "765 Route 70 E",
            "city": "Marlton",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080532341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marlton, NJ

Sources for this page

Verify at the official NPI Registry.