Jensy Pulikamalil Stafford, MD

Primary specialty

Hospice and Palliative Medicine (Family Medicine) PhysicianTaxonomy code 207QH0002X

License

13939 Issued in RI

Practice address

1085 N Main St
Providence, RI 02904-5719

Phone

(401) 415-4242

Fax

(401) 312-2356

NPI assigned

Jul 7, 2008

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

• Jensy Pulikamalil Jacob Former name

Medicare fee-for-service enrollment

Enrolled in RI

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 1

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 and National Provider Directory roles.

• Hopehealth Hospice & Palliative Care

  • Case Management Agency
  • Providence, RI
  • NPI 1790851590
  Medicare reassignment NPD
• Hopehealth Hospice & Palliative Care

  • General Practice Physician
  • Brockton, MA
  • NPI 1720405988
  NPD

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

{
    "created_epoch": "1215388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342137600000",
    "number": "1922261353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1085 N MAIN ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029045719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1085 N MAIN ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029045719",
            "telephone_number": "401-415-4242",
            "fax_number": "401-312-2356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAFFORD",
        "first_name": "JENSY",
        "middle_name": "PULIKAMALIL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-07",
        "last_updated": "2012-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "246929",
            "primary": false
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "RI",
            "license": "13939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENSY",
            "last_name": "JACOB",
            "middle_name": "PULIKAMALIL",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Flora Mae Gregorio Sta. Ines, M.D.
• Julia Stacey
• Dariusz Stachurski, M.D.
• Peter J. Stack, MSPT
• Heidi Eve Stafford, RN
• Todd S Stafford, MD
• Brian F Stainken, M.D.
• Vladimir Stamoran, MD
• Jessica Anne Stanelun
• David James Stanford, MSW, LICSW, LCDP II

• Hospice and Palliative Medicine (Family Medicine) Physician in Providence, RI
• Providers in Providence, RI by specialty
• Hospice and Palliative Medicine (Family Medicine) Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.