Organization Active NPI

JBR Wound Management LLC

  • Adult Health Nurse Practitioner
  • Willow Grove, PA
National Provider Identifier
1972067726
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
Legal business name
JBR WOUND MANAGEMENT LLC
Practice address
177 Duffield St
Willow Grove, PA 19090-2106
Phone
(215) 460-7705
Fax
(215) 659-2921
NPI assigned
Jan 25, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Janice B Rosenbaum, CRNPNPI 1578767372
Title
President
Phone
(215) 460-7705

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LA2200X Primary

Addresses

Primary practice location

177 Duffield St
Willow Grove, PA 19090-2106

Mailing address

1637 E Butler Pike
Ambler, PA 19002-2733
Phone (215) 460-7705

Other identifiers 1

IdentifierTypeStateIssuer
0019495890005MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190308000199 PA Part B Supplier - Clinic/Group Practice 8426397449 Receives reassigned benefits from 1 practitioner
Practice locations: Ambler, PA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1548374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1972067726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1637 E BUTLER PIKE",
            "city": "AMBLER",
            "state": "PA",
            "postal_code": "190022733",
            "telephone_number": "215-460-7705",
            "fax_number": "215-540-3979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "177 DUFFIELD ST",
            "city": "WILLOW GROVE",
            "state": "PA",
            "postal_code": "190902106",
            "telephone_number": "215-460-7705",
            "fax_number": "215-659-2921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JBR WOUND MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-25",
        "last_updated": "2023-03-07",
        "certification_date": "2020-09-15",
        "status": "A",
        "authorized_official_last_name": "ROSENBAUM",
        "authorized_official_first_name": "JANICE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-460-7705",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0019495890005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Willow Grove, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.