Individual provider Active NPI

Jenelle Hazzard, FNPC

  • Nurse Practitioner
  • Brewer, ME
National Provider Identifier
1821549445
Registry record updated May 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
CNP161151 Issued in ME
Practice address
735 Wilson St.
Brewer, ME 04412
Phone
(207) 989-1567
NPI assigned
Oct 19, 2016
Last updated
May 6, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X CNP161151 ME Primary

Addresses

Primary practice location

735 Wilson St.
Brewer, ME 04412

Mailing address

PO Box 1599
Bangor, ME 04402-1599

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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
I20161214000487 ME Practitioner - Nurse Practitioner 5799065587 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Penobscot Community Health CenterGroup PAC ID 0143212670, 135 clinicians

Practice addresses (Care Compare)

735 Wilson St
Brewer, ME 04412-1000
Phone (207) 989-1567

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Penobscot Community Health Center CurrentSince Oct 21, 2016 Accepting new patients
Penobscot Community Health Center Current Accepting new patients
Penobscot Community Health Center CurrentSince Oct 21, 2016 Accepting new patients
Penobscot Community Health Center Past Accepting new patients

Locations

1012 Union St
Ste 1
Bangor, ME 04401
Phone 2079455247407

29 Schoodic Dr
Belfast, ME 04915
Phone (207) 218-6001

53 Schoodic Dr
Belfast, ME 04915
Phone (207) 338-6900

735 Wilson St
Brewer, ME 04412
Phone (207) 989-1567

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 2

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": "1476835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620259200000",
    "number": "1821549445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 WILSON ST.",
            "city": "BREWER",
            "state": "ME",
            "postal_code": "04412",
            "telephone_number": "207-989-1567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAZZARD",
        "first_name": "JENELLE",
        "credential": "FNPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-19",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ME",
            "license": "CNP161151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brewer, ME

Sources for this page

Verify at the official NPI Registry.