JESSICA FERNANDES CANUTO (AGNP-C) – Geriatric Medicine (Family Medicine) Physician, NPI 1154134393

JESSICA FERNANDES CANUTO (AGNP-C) is a healthcare provider. based in Brockton, Massachusetts. specializing in NURSE PRACTITIONER. They hold the professional credentials AGNP-C. They hold a License No. RN2361476 (MA). The NPI Number for JESSICA FERNANDES CANUTO (AGNP-C) is 1154134393

Main info

Female
Sole Proprietor
2 Years Of Experience
Name
JESSICA FERNANDES CANUTO (AGNP-C)
NPI
1154134393
Phone
Not provided
Address
45 EDSON ST
Enumeration Date
30 January 2025
Last Update Date
30 January 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5087470780
Graduation Year
2024 (2 years ago)
PAC ID
7012433691
Group Practice PAC ID
4486053121
Professional Enrollment ID
I20250428000612
Address ID
MA02360XXXXPLXXXXXXXXXX00
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience26
Completeness75
Years active:1State licenses:1Digital endpointsOther names

8,972 NURSE PRACTITIONER in MA

Provider Addresses for JESSICA FERNANDES CANUTO (AGNP-C)

  • 45 EDSON ST

    BROCKTON, MA 023024109

    Phone:

    Mailing address matches the actual address.

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: 2025-04-28

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250428000612INurse PractitionerMATBD

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.

Verify on CMS Revalidation Lookup Tool

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 02302)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4486053121View full group profile
NameSpecialtyState
Nurse PractitionerMA
Nurse PractitionerMA

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Frequently asked questions

Is there an official ID for JESSICA FERNANDES CANUTO (AGNP-C) in U.S. healthcare records?
The official identifier for JESSICA FERNANDES CANUTO (AGNP-C) is NPI 1154134393.
Is JESSICA FERNANDES CANUTO (AGNP-C) still an active registrant?
JESSICA FERNANDES CANUTO (AGNP-C) carries an active NPI according to the public dataset.
How would a patient describe JESSICA FERNANDES CANUTO (AGNP-C)'s focus?
For JESSICA FERNANDES CANUTO (AGNP-C), the primary taxonomy reads as Geriatric Medicine (Family Medicine) Physician. Clinical services aligned with this taxonomy classification.
What locale is associated with JESSICA FERNANDES CANUTO (AGNP-C)?
Directory geography for JESSICA FERNANDES CANUTO (AGNP-C) centers on Brockton, Massachusetts.
When was this NPI issued?
Enumeration for JESSICA FERNANDES CANUTO (AGNP-C) is noted as January 30, 2025 where the registry provides it.

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