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Jarrod Robert Severeide

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

200 Hawthorne Ln, Charlotte, NC 28204-2515

PECOS Enrollment

This provider is enrolled in PECOS as JARROD SEVEREIDE.

Based on the most recent information from CMS, provider Jarrod Robert Severeide is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 10:34 AM.

Profile Details

Provider ID
1376072678
Provider Type
Individual
Full Name
Severeide, Jarrod Robert
Credential
ARNP

Gender
Male
Sole Proprietor
No
Enumeration Date
6/8/2017
Last Updated
6/18/2020

Contact Information

Practice Location

200 Hawthorne Ln, Charlotte, NC 28204-2515

(704) 384-8785

Unlisted Fax

Mailing Location

101 Sedgewood Dr, Rock Hill, SC 29732-2315

(316) 619-7322

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 21066 South Carolina

Jarrod Robert Severeide

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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