NPIMap

Individual provider Active NPI

Jonathan Daniel Hancock

  • Adult Health Nurse Practitioner
  • Fayetteville, NC
National Provider Identifier
1780816223
Registry record updated Mar 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
5004563 Issued in NC
Practice address
1074 Southern Ave
Fayetteville, NC 28306-1766
Phone
(910) 491-4530
Fax
(910) 491-6093
NPI assigned
Aug 18, 2009
Last updated
Mar 21, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 5004563 NC Primary

Addresses

Primary practice location

1074 Southern Ave
Fayetteville, NC 28306-1766

Mailing address

PO Box 727
Stedman, NC 28391-0727
Phone (910) 491-4530

Other identifiers 1

IdentifierTypeStateIssuer
5004563OtherNCNC LISCENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20100202000936 NC Practitioner - Nurse Practitioner 6103969951 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Simpleclinic PLLCGroup PAC ID 2264730621, 7 clinicians

Practice addresses (Care Compare)

1515 Sunset Ave
Clinton, NC 28328-3827
Phone (910) 491-9418

2414 Hope Mills Rd
Fayetteville, NC 28304-4264
Phone (910) 437-9905

3551 Dunn Rd
Suite 101
Eastover, NC 28312-9417
Phone (910) 483-6277

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5004563NCMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Simpleclinic PLLC CurrentSince Feb 6, 2016 Accepting new patients
Charles Otis Boyette MD Past Accepting new patients
Simpleclinic PLLC Past Accepting new patients
Simpleclinic PLLC Past Accepting new patients

Locations

1515 Sunset Ave
Clinton, NC 28328
Phone (910) 491-9418

3551 Dunn Rd
Ste 101
Eastover, NC 28312
Phone (910) 483-6277

1074 Southern Ave
Fayetteville, NC 28306
Phone (910) 221-1590

Interoperability endpoints

  • Direct secure messaging: jhancock119110@capefearvalley.direct-ci.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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1250553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490054400000",
    "number": "1780816223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 727",
            "city": "STEDMAN",
            "state": "NC",
            "postal_code": "283910727",
            "telephone_number": "910-491-4530",
            "fax_number": "910-491-6093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1074 SOUTHERN AVE",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283061766",
            "telephone_number": "910-491-4530",
            "fax_number": "910-491-6093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANCOCK",
        "first_name": "JONATHAN",
        "middle_name": "DANIEL",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-18",
        "last_updated": "2017-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "5004563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC LISCENSE",
            "identifier": "5004563",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.