NPIMap

Individual provider Active NPI

Jacqueline Blake Russ, APRN

  • Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1891279584
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3012682 Issued in KY
Practice address
4123 Dutchmans LN Ste 307
Louisville, KY 40207-4721
Phone
(502) 409-5600
Fax
(502) 259-3078
NPI assigned
Sep 19, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

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 3012682 KY Primary

Addresses

Primary practice location

4123 Dutchmans LN Ste 307
Louisville, KY 40207-4721

Mailing address

PO Box 776351
Chicago, IL 60677-6351
Phone (502) 588-9490

Other practice location 1

100 Mallard Creek Rd Ste 406
Louisville, KY 40207-5166
Phone (502) 895-4607

Other practice location 2

4001 Dutchmans Ln
Louisville, KY 40207-4714
Phone (502) 893-1000

Other names 1

  • Jacqueline Blake Hix Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20190305002318 KY Practitioner - Nurse Practitioner 0749529980 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
SN Kentuckiana Rehab, LLCGroup PAC ID 1254671464, shared by 19 NPIs, 339 clinicians
Community Medical Associates IncGroup PAC ID 7012811284, 1,368 clinicians

Practice addresses (Care Compare)

12613 Taylorsville Rd
Suite 118
Louisville, KY 40299-5496
Phone (502) 267-1480

4123 Dutchmans LN
Louisville, KY 40207-4721

825 Barret Ave
Louisville, KY 40204-1743
Phone (502) 272-5165

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.11 of 100Reported as group
Quality
63.34
Promoting interoperability
100
Improvement activities
40
Cost
73.68

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical Associates, Inc. Nurse Practitioner CurrentSince Jan 1, 2021 Accepting new patients
Community Medical Associates, Inc. Nurse Practitioner Current Accepting new patients
Community Medical Associates, Inc. CurrentSince Jan 1, 2021 Accepting new patients
Community Medical Associates, Inc. Nurse Practitioner Past Accepting new patients

Locations

4123 Dutchmans Ln
Ste 515
Louisville, KY 40207
Phone (502) 899-6900

4123 Dutchmans Ln
Ste 307
Louisville, KY 40207
Phone (502) 409-5600

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

150 Frankfort Rd
Ste 104B
Shelbyville, KY 40065

Interoperability endpoints

  • Direct secure messaging: jruss53913@direct.nortonhealthcare.org

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 and National Provider Directory roles.

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": "1537315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1891279584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776351",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776351",
            "telephone_number": "502-588-9490",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4123 DUTCHMANS LN STE 307",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074721",
            "telephone_number": "502-409-5600",
            "fax_number": "502-259-3078"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Mallard Creek Rd Ste 406",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402075166",
            "country_code": "US",
            "telephone_number": "502-895-4607",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4001 Dutchmans Ln",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402074714",
            "country_code": "US",
            "telephone_number": "502-893-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSS",
        "first_name": "JACQUELINE",
        "middle_name": "BLAKE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-19",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3012682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "HIX",
            "middle_name": "BLAKE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.