Nicole Beall Jaques, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

45895 Issued in TN

Practice address

105 Redbud Dr
Emergency Department
Portland, TN 37148-1673

Phone

(615) 745-8150

NPI assigned

Mar 27, 2008

Last updated

Jan 13, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Nicole Beall Professional name

Medicare fee-for-service enrollment

Enrolled in TN, FL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Emergency Medicine

Education

Loyola University of Chicago, Stritch School of Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Paragon Emergency Services LLCGroup PAC ID 8628153087, 401 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida Putnam Hospital Hospital, Palatka, FL, CCN 100232

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Paragon Emergency Services LLC

  • Emergency Medicine Physician
  • Winter Haven, FL
  • NPI 1912101650
  Medicare reassignment Care Compare group NPD
• University of Tennessee

  • Family Medicine Physician
  • Jackson, TN
  • NPI 1780686436
  Medicare reassignment NPD
• Emergency Medicine Services of FL, LLC

  • Emergency Medicine Physician
  • Aventura, FL
  • NPI 1043917180
  Medicare reassignment NPD
• New Smyrna Beach Urgent Care, LLC

  • Basic Emergency Medical Technician
  • New Smyrna Beach, FL
  • NPI 1801126297
  Medicare reassignment NPD
• Emergency Physicians Inc

  dba Emergency Resources Group

  • Emergency Medicine Physician
  • Jacksonville, FL
  • NPI 1285686675
  Medicare reassignment
• University of Tennessee

  dba Univ. of TN Health Science Center College of Nursing

  • Family Nurse Practitioner
  • Memphis, TN
  • NPI 1174221337
  NPD
• WT University Medical Associates Inc

  dba West Tennessee Medical Group UT Medicine

  • Family Medicine Physician
  • Jackson, TN
  • NPI 1023572344
  NPD

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

• Putnam Community Medical Center of North Florida, LLC

  dba HCA Florida Putnam Hospital

  • General Acute Care Hospital
  • Palatka, FL
  • NPI 1487045100
  Care Compare affiliation

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

{
    "created_epoch": "1206576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421107200000",
    "number": "1851563019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 REDBUD DR",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "PORTLAND",
            "state": "TN",
            "postal_code": "371481673",
            "telephone_number": "615-745-8150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 REDBUD DR",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "PORTLAND",
            "state": "TN",
            "postal_code": "371481673",
            "telephone_number": "615-745-8150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAQUES",
        "first_name": "NICOLE",
        "middle_name": "BEALL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-27",
        "last_updated": "2015-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "45895",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "45895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "BEALL",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Chasity Henson
• Julie A. Hicks, RN
• Lydia Ellen Hicks, RN
• Sherelen Hodges, NP
• Hospital Based Medical Services of Tennessee-I PC
• John a Taylor MD
• Ashley Jones, FNP
• Kimberly Jones
• JRM Contracting
• Edward Freeman Kirkpatrick Jr., DDS

• Family Medicine Physician in Portland, TN
• Providers in Portland, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.