Jacqueline Channell, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

ARNP9278612 Issued in FL

Practice address

4520 Executive Dr Ste 227
San Diego, CA 92121-3020

Phone

(888) 777-1945

Fax

(805) 413-9099

NPI assigned

Sep 19, 2017

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

Medicare fee-for-service enrollment

Enrolled in MP, WV2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Group practices

United Summit Center IncGroup PAC ID 6002803988, 14 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• West Virginia University Hospitals, Inc Hospital, Morgantown, WV, CCN 510001

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jacqueline.channell.p1@direct.ifh.nextgenshare.com
• Direct secure messaging: jacqueline.channell@13475020865540.direct.elationemr.com

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.

• United Summit Center Inc

  • Mental Health Counselor
  • Clarksburg, WV
  • NPI 1750332524
  Medicare reassignment Care Compare group
• Commonwealth Healthcare Corporation

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Saipan, MP
  • NPI 1285858290
  Medicare reassignment NPD
• Infusion4Health

  • Infusion Therapy Clinic/Center
  • Thousand Oaks, CA
  • NPI 1508262213
  NPD
• Bishop Health Florida, LLC

  • Psychiatry Physician
  • Delray Beach, FL
  • NPI 1215676192
  NPD
• Commonwealth Healthcare Corporation

  • General Acute Care Hospital
  • Saipan, MP
  • NPI 1871616292
  NPD
• PA Post Acute Services PC

  • General Practice Physician
  • Masury, OH
  • NPI 1255057063
  NPD
• Stonerise Services, LLC

  • Nurse Practitioner
  • Charleston, WV
  • NPI 1558743849

  Family

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• West Virginia University Hospitals, Inc

  • General Acute Care Hospital
  • Morgantown, WV
  • NPI 1841271459
  Care Compare affiliation

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

{
    "created_epoch": "1505779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663200000000",
    "number": "1942729173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 STONE HARBOR WAY APT F1",
            "city": "DELRAY BEACH",
            "state": "FL",
            "postal_code": "334443407",
            "telephone_number": "561-445-5761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4520 EXECUTIVE DR STE 227",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213020",
            "telephone_number": "888-777-1945",
            "fax_number": "805-413-9099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Stone Harbor Way F1",
            "address_purpose": "LOCATION",
            "city": "Delray Beach",
            "state": "FL",
            "postal_code": "33444",
            "country_code": "US",
            "telephone_number": "561-445-5761",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHANNELL",
        "first_name": "JACQUELINE",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-19",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9278612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yufang Jennifer Chang, M.D.
• Yuling Chang
• Yunghui Melody Chang
• Maureen Changnon, PPS
• Hetal Vrajlal Chaniara, PHARM.D.
• Elizabeth Ann Chantala, NP
• Valerie Raquel Consunji Chanthaluxay
• David Chao, M.D.
• David J Chao, MD
• Edward Chen Chao, DO

• Family Nurse Practitioner in San Diego, CA
• Providers in San Diego, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2022; 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.