Mind and Soul – Adult Health Nurse Practitioner, NPI 1124250352
Adult Health Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Mind and Soul
101 Elwin Ln
Jacksonville, VT 053429691
Phone: (732) 742-9067
Type: Location
163, North Main Street, North Brookfield, Worcester County, Massachusetts, 01535, United States
NORTH BROOKFIELD, MA 015351400
Phone: (508) 637-1604
Fax: (508) 637-1605
Type: Mailing
PO BOX 576
JACKSONVILLE, VT 053420576
Phone: (508) 637-1604
Type: Mailing
2948 VT ROUTE 100
JACKSONVILLE, VT 053429510
Phone: (802) 435-0616
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: 2022-09-08
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 |
|---|---|---|---|---|
| O20091105000552 | O | Clinic/Group Practice | MA | TBD |
| O20220908002954 | O | Clinic/Group Practice | VT | 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 05342)
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