Jennifer Ann Shade

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

RN164008 Issued in AZ

Practice address

1740 E Beverly Ave Ste B
Kingman, AZ 86409-3564

Phone

(928) 263-1335

Fax

(928) 272-0173

NPI assigned

Dec 2, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Ann Giffin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Merit-based Incentive Payment System (MIPS)

Final score

84.85 of 100Reported as group

Quality

84.49

Promoting interoperability

83

Improvement activities

40

Cost

79.17

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Exceptional Health Care Bullhead City LLC

  • Special Hospital
  • Bullhead City, AZ
  • NPI 1750092110
  NPD (past)

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

{
    "created_epoch": "1575244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710547200000",
    "number": "1922645696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1740 E BEVERLY AVE STE B",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864093564",
            "telephone_number": "928-263-1335",
            "fax_number": "928-272-0173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 E BEVERLY AVE STE B",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864093564",
            "telephone_number": "928-263-1335",
            "fax_number": "928-272-0173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADE",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-02",
        "last_updated": "2024-03-16",
        "certification_date": "2024-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "AZ",
            "license": "RN164008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "GIFFIN",
            "middle_name": "ANN",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Akilan Selvaraju, D.O.
• Joe Ren'E Serna, M.D.
• Michael Serrano
• Jonathon Allen Sexton, DO
• Traniece Seymour
• Belal Mohammad Sharaf, MD
• Carol Ann Sharpe, TRANSPORTATION
• Andrea Sheehan, FNP-BC
• Michael Edward Sheehy, DO
• Sheila R Mane MD PC

• Primary Care Nurse Practitioner in Kingman, AZ
• Providers in Kingman, AZ by specialty
• Primary Care Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.

Verify at the official NPI Registry.