NPIMap

Individual provider Active NPI

Jessica Ann Eastman, CNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Baxter, MN
National Provider Identifier
1780274563
Registry record updated Aug 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
7955 Issued in MN
Practice address
7115 Forthun Rd #105
Baxter, MN 56425
Phone
(218) 454-0090
NPI assigned
Jan 25, 2021
Last updated
Aug 11, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2021

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 7955 MN Primary

Addresses

Primary practice location

7115 Forthun Rd #105
Baxter, MN 56425

Mailing address

7115 Forthun Rd Suite 105
Baxter, MN 56425
Phone (218) 454-0090

Other names 1

  • Jessica Ann Reese Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20210316001152 MN Practitioner - Nurse Practitioner 6406262591 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

11671 Fountains Dr
Suite 200
Maple Grove, MN 55369-4784
Phone (612) 223-8898

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7955MNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
David C. Anderholm, MD, PA CurrentSince Feb 9, 2021 Accepting new patients
Optum Behavioral Care of Colorado, P.C. CurrentSince May 13, 2024 Accepting new patients
Optum Behavioral Care of Colorado, P.C. CurrentSince May 13, 2024 Accepting new patients
Optum Behavioral Care of Colorado PC PastSince Feb 23, 2025 Accepting new patients

Locations

7115 Forthun Rd
Ste 105
Baxter, MN 56425
Phone (218) 454-0090

7400 W 109th St
Bloomington, MN 55438
Phone (952) 886-3268

11671 Fountains Dr N
Ste 200
Maple Grove, MN 55369
Phone (763) 585-0600

7601 Wayzata Blvd
St Louis Park, MN 55426
Phone (612) 223-8899

Interoperability endpoints

  • Direct secure messaging: jessica.eastman.1@28621.direct.athenahealth.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 11

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": "1611532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628640000000",
    "number": "1780274563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7115 FORTHUN RD SUITE 105",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "56425",
            "telephone_number": "218-454-0090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7115 FORTHUN RD #105",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "56425",
            "telephone_number": "218-454-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EASTMAN",
        "first_name": "JESSICA",
        "middle_name": "ANN",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-25",
        "last_updated": "2021-08-11",
        "certification_date": "2021-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "7955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "REESE",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Baxter, MN

Sources for this page

Verify at the official NPI Registry.