Active NPI
Jacqueline R Sly, FNP, DNP
- Interventional Cardiology Physician
- Brockton, MA
National Provider Identifier
1912284316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Interventional Cardiology Physician
- License
- CNP221579
- Practice address
- 110 Liberty St
Brockton, MA 02301 - Phone
- (508) 894-0400
- Fax
- (508) 894-0356
- NPI assigned
- Nov 14, 2011
- Last updated
- Aug 9, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | CNP221579 | ME | |
| Family Health Clinical Nurse Specialist | 364SF0001X | RN189769 | MA | |
| Interventional Cardiology Physician | 207RI0011X | CNP221579 | ME | Primary |
Addresses
Primary practice location
110 Liberty St
Brockton, MA 02301
Mailing address
8 Pikes HL
Norway, ME 04268-5340
Phone (207) 744-6444
Other practice location 1
2 Great Falls Plz Ste 21
Auburn, ME 04210-5966
Phone (207) 330-3950
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mainehealth
Practice addresses (Care Compare)
22 Bramhall St
Portland, ME 04102-3134
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 97.93 of 100
- Quality
- 83.31
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN189769 | MA | MD | Family Health Clinical Nurse Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mainehealth | Current | Accepting new patients | |
| Mainehealth | Current | Accepting new patients | |
| St. Mary's Regional Medical Center | Current | Accepting new patients | |
| Mainehealth | Current | Accepting new patients | |
| Mainehealth | Current | Accepting new patients | |
| St. Mary's Regional Medical Center | Current | Accepting new patients |
Locations
100 Campus Ave
Ste 104
Lewiston, ME 04240
Phone (207) 755-3445
93 Campus Ave
Lewiston, ME 04240
Phone (207) 755-3715
8 Pikes Hl
Norway, ME 04268
Phone (207) 743-9292
22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179
Interoperability endpoints
- jsly1444237@direct.bsmhealth.org
- jsly710425@direct.mmc.mainehealth.org
Organizations & group practices 6
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.
-
- General Acute Care Hospital
- Lewiston, ME
- NPI 1447226584
-
dba MaineHealth Pharmacy Brighton Ave
- Community/Retail Pharmacy
- Portland, ME
- NPI 1013868181
-
dba St. Mary's d'Youville Pavilion
- Skilled Nursing Facility
- Lewiston, ME
- NPI 1952306524
Hospital & facility affiliations 1
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": "1321228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723161600000",
"number": "1912284316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8 PIKES HL",
"city": "NORWAY",
"state": "ME",
"postal_code": "042685340",
"telephone_number": "207-744-6444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 LIBERTY ST",
"city": "BROCKTON",
"state": "MA",
"postal_code": "02301",
"telephone_number": "508-894-0400",
"fax_number": "508-894-0356"
}
],
"practiceLocations": [
{
"address_1": "2 Great Falls Plz Ste 21",
"address_purpose": "LOCATION",
"city": "Auburn",
"state": "ME",
"postal_code": "042105966",
"country_code": "US",
"telephone_number": "207-330-3950",
"fax_number": "207-330-3955",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SLY",
"first_name": "JACQUELINE",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "FNP, DNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-14",
"last_updated": "2024-08-09",
"certification_date": "2024-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "ME",
"license": "CNP221579",
"primary": false
},
{
"code": "364SF0001X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist, Family Health",
"state": "MA",
"license": "RN189769",
"primary": false
},
{
"code": "207RI0011X",
"taxonomy_group": "",
"desc": "Internal Medicine, Interventional Cardiology",
"state": "ME",
"license": "CNP221579",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2024; 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.