JACQUELINE LEWIS (NP) – Family Nurse Practitioner, NPI 1093263071
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for JACQUELINE LEWIS (NP)
2732 Candler Rd
Decatur, GA 300341410
Phone: (470) 444-3133
Fax: (470) 276-4051
Type: Location
PO BOX 740015
ATLANTA, GA 303740015
Phone: (312) 773-9730
Type: Mailing
2107, North Decatur Road, North Decatur, DeKalb County, Georgia, 30033, United States
SUITE 120
DECATUR, GA 300335305
Phone: (404) 552-5128
Type: Mailing
304 SUMMIT HEIGHTS CT STE 120
ELLENWOOD, GA 302942973
Phone: (404) 552-5128
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-03-07
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20170920002832 | I | Nurse Practitioner | GA | TBD |
| I20240307000573 | I | Nurse Practitioner | VA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30034)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | GA | |
| - | FL | |
| - | GA | |
| - | GA | |
| Nurse Practitioner | PA | |
| - | NY | |
| - | GA | |
| - | GA |
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