NPIMap

Individual provider Active NPI

Jennifer Lynn Maxim, CRNP

  • Nurse Practitioner
  • Du Bois, PA
National Provider Identifier
1821765595
Registry record updated Aug 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
SP023852 Issued in PA
Practice address
100 Hospital Ave
Du Bois, PA 15801-1440
Phone
(814) 371-2200
NPI assigned
Aug 30, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 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 SP023852 PA Primary

Addresses

Primary practice location

100 Hospital Ave
Du Bois, PA 15801-1440

Mailing address

343 W Liberty Rd
Reynoldsville, PA 15851-5707
Phone (814) 952-9130

Other practice location 1

871 Beaver Dr
Du Bois, PA 15801-2511
Phone (814) 375-0455

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jlmaxim@phhealthcare.org Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20220324002902 PA Practitioner - Nurse Practitioner 0648665802 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dubois Regional Medical CenterGroup PAC ID 5890689715, 424 clinicians

Practice addresses (Care Compare)

145 Hospital Ave
Suite 315
Du Bois, PA 15801-1465
Phone (814) 503-4305

1900 River Rd
Clearfield, PA 16830-6026
Phone (814) 205-1250

621 S Main St
Penn Highlands Q Care Dubois
Dubois, PA 15801-1413
Phone (814) 299-7520

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.6 of 100Reported as group
Promoting interoperability
96
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Dubois Regional Medical Center CurrentSince Dec 14, 2021 Accepting new patients
Brookville Hospital CurrentSince Dec 1, 2025 Accepting new patients
Brookville Hospital Nurse Practitioner CurrentSince Dec 1, 2025 Accepting new patients
Dubois Regional Medical Center CurrentSince Dec 14, 2021 Accepting new patients
Clearfield Jefferson Head and Neck Surgical Associates, Inc. PastSince Feb 12, 1999 Accepting new patients

Locations

100 Hospital Rd
Brookville, PA 15825
Phone (814) 849-1408

100 Hospital Ave
Dubois, PA 15801
Phone (814) 375-2040

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.

Hospital & facility affiliations 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1630281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630281600000",
    "number": "1821765595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 W LIBERTY RD",
            "city": "REYNOLDSVILLE",
            "state": "PA",
            "postal_code": "158515707",
            "telephone_number": "814-952-9130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL AVE",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158011440",
            "telephone_number": "814-371-2200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "871 Beaver Dr",
            "address_purpose": "LOCATION",
            "city": "Du Bois",
            "state": "PA",
            "postal_code": "158012511",
            "country_code": "US",
            "telephone_number": "814-375-0455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAXIM",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-30",
        "last_updated": "2021-08-30",
        "certification_date": "2021-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP023852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jlmaxim@phhealthcare.org",
            "affiliation": "N",
            "endpointDescription": "work",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "100 Hospital Ave",
            "city": "Du Bois",
            "state": "PA",
            "country_code": "US",
            "postal_code": "158011440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Du Bois, PA

Sources for this page

Verify at the official NPI Registry.