Individual provider Active NPI

Jessica Marie Newbury

  • Family Nurse Practitioner
  • Waterbury, CT
National Provider Identifier
1790543486
Registry record updated Oct 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
12947 Issued in CT
Practice address
80 Phoenix Ave
Waterbury, CT 06702-1418
Phone
(203) 756-8021
NPI assigned
Mar 8, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 12947 CT Primary

Addresses

Primary practice location

80 Phoenix Ave
Waterbury, CT 06702-1418

Mailing address

1302 S Main St
Waterbury, CT 06706-1748
Phone (203) 756-8021

Other practice location 1

187 S Canaan Rd
Canaan, CT 06018-2544
Phone (860) 824-1397

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20240506003632 CT Practitioner - Nurse Practitioner 3476993502 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Staywell Health Care Inc.Group PAC ID 6305750480, 43 clinicians

Practice addresses (Care Compare)

1302 S Main St
Waterbury, CT 06706-1748
Phone (203) 756-8021

402 E Main St
Waterbury, CT 06702-1701
Phone (203) 755-1143

80 Phoenix Ave
Waterbury, CT 06702-1418
Phone (203) 757-5491

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Staywell Health Care, Inc. CurrentSince Apr 11, 2024 Accepting new patients
Staywell Health Care Inc Past Accepting new patients

Locations

30 Church St
Naugatuck, CT 06770
Phone (203) 805-4929

1309 S Main St
Waterbury, CT 06706
Phone (203) 597-9044

402 E Main St
Waterbury, CT 06702
Phone (203) 755-1143

80 Phoenix Ave
Waterbury, CT 06702
Phone (203) 573-1800

80 Phoenix Ave
Ste 201
Waterbury, CT 06702
Phone (203) 757-5491

80 Phoenix Ave
Ste 301
Waterbury, CT 06702

114 Benedict St
Waterbury, CT 06706

1302 S Main St
Waterbury, CT 06706
Phone (203) 597-9044

Organizations & group practices 2

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 1

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": "1709856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729987200000",
    "number": "1790543486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 S MAIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067061748",
            "telephone_number": "203-756-8021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 PHOENIX AVE",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067021418",
            "telephone_number": "203-756-8021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "187 S Canaan Rd",
            "address_purpose": "LOCATION",
            "city": "Canaan",
            "state": "CT",
            "postal_code": "060182544",
            "country_code": "US",
            "telephone_number": "860-824-1397",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NEWBURY",
        "first_name": "JESSICA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-08",
        "last_updated": "2024-10-27",
        "certification_date": "2024-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "12947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

Verify at the official NPI Registry.