Individual provider Active NPI

Jane Smallcomb, RN

  • Registered Nurse
  • Wilkes Barre, PA
National Provider Identifier
1912122789
Registry record updated Jun 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
RN333036L Issued in PA
Practice address
15 Public SQ
Suite 312
Wilkes Barre, PA 18701-1702
Phone
(570) 826-1777
Fax
(570) 823-3040
NPI assigned
Apr 16, 2007
Last updated
Jun 21, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN333036L PA Primary

Addresses

Primary practice location

15 Public SQ
Suite 312
Wilkes Barre, PA 18701-1702

Mailing address

15 Public SQ
Suite 600
Wilkes Barre, PA 18701-1702
Phone (570) 826-1777

Other identifiers 2

IdentifierTypeStateIssuer
1015952320003MedicaidPA
1007678420038MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN333036LPAMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308614400000",
    "number": "1912122789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 PUBLIC SQ",
            "address_2": "SUITE 600",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187011702",
            "telephone_number": "570-826-1777",
            "fax_number": "570-823-3040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 PUBLIC SQ",
            "address_2": "SUITE 312",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187011702",
            "telephone_number": "570-826-1777",
            "fax_number": "570-823-3040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMALLCOMB",
        "first_name": "JANE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-16",
        "last_updated": "2011-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN333036L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1015952320003",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007678420038",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.