MARY JILL VAILLANCOURT CRNP
NPI 1104290915
Nurse Practitioner - Adult Health in Jamestown, NY

Q: What is Mary Vaillancourt's NPI number?

The NPI number for Mary Vaillancourt is 1104290915. It was assigned to this individual provider in the NPPES registry on November 17, 2015.

Q: What is Mary Vaillancourt's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

Q: When was this NPI record last updated?

The NPPES record for Mary Vaillancourt was last updated on August 31, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since November 17, 2015PECOS Enrolled

107 INSTITUTE ST, JAMESTOWN, NY 14701(716) 484-4334(833) 974-2029 Get Directions Write a Review

NPPES record last updated: August 31, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Aug 31, 2023, Nov 24, 2015, Nov 18, 2015 (3 updates tracked since 2015).

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About Mary Jill Vaillancourt Crnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY JILL VAILLANCOURT CRNP (NPI 1104290915) is an individual adult health provider in Jamestown, New York, licensed in New York (F307302) and active in the NPI registry since November 2015. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104290915

Entity TypeIndividualFemale

Primary Taxonomy363LA2200X

Provider Legal NameMARY JILL VAILLANCOURTCredential: CRNP

Location Address107 INSTITUTE STJamestown, NY 14701-6628

Mailing Address107 Institute StJamestown, NY 14701-6628 · (716) 484-4334 · Fax (833) 974-2029

Phone(716) 484-4334

Fax(833) 974-2029

Sole ProprietorNo

Enumeration DateNovember 17, 2015

Last NPPES UpdateAugust 31, 20233 updates tracked since enumeration

NPPES CertifiedAugust 31, 2023

✔ NPI 1104290915 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LA2200X

Licenses✔ Licensed in NY · F307302✔ Licensed in PA · SP015710

Also ListedRegistered NurseTaxonomy 163W00000X · License RN578441 (PA), 362456 (NY)

Also ListedNurse PractitionerTaxonomy 363L00000X · License SP015710 (PA)

Also ListedNurse Practitioner · GerontologyTaxonomy 363LG0600X · License SP015710 (PA)

107 INSTITUTE ST, Jamestown, NY 14701

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mary Jill Vaillancourt Crnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Mary Vaillancourt reassigns Medicare billing to 5 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Great Lakes Physician Practice PC

0.1 mi

Internal Medicine

15 S MAIN ST
Jamestown, NY 14701

Reassigned Medicare billing, New York enrollment
233 clinicians in this Medicare group

NPI 1730599176 (716) 488-1877

Family Health Medical Services PLLC

0.1 mi

Family Medicine

103 ALLEN ST
Jamestown, NY 14701

Reassigned Medicare billing, New York enrollment
11 clinicians in this Medicare group

NPI 1619072204 (716) 338-0022

Westfield Family Physicians,pc

24 mi

Primary Care

138 E MAIN ST
Westfield, NY 14787

Reassigned Medicare billing, New York enrollment
16 clinicians in this Medicare group

NPI 1245263557 (716) 326-4678

The Chautauqua Center, Inc

28 mi

Federally Qualified Health Center (FQHC)

75 E 3RD ST
Dunkirk, NY 14048

Reassigned Medicare billing, New York enrollment
63 clinicians in this Medicare group

NPI 1760747521 (716) 363-6050

Apogee Medical Group, New York, PC

1,867 mi

Internal Medicine

15059 N SCOTTSDALE ROAD, SUITE 600
Scottsdale, AZ 85254

Reassigned Medicare billing, New York enrollment
354 clinicians in this Medicare group

NPI 1841520236 (602) 778-3600

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Hemoglobin a1c level 83036

Hemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.

20 services14 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 14701 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$84.93 typical visit price

range $54.87 – $166.88

Typical copayment $21.23 (range $13.71 – $41.72)

Most-billed visit code 99203

Established Patient

$97.08 typical visit price

range $17.54 – $136.14

Typical copayment $24.27 (range $4.38 – $34.03)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Standard wheelchair K0001

DME-Wheelchairs · category DD000N

1 supplier11 claims11 services$21.30 avg. paid by Medicare

Elevating leg rests, pair (for use with capped rental wheelchair base) K0195

DME-Wheelchairs · category DD021N

1 supplier11 claims11 services$8.65 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHELSEA JULIANN MURPHY M.S. CCC-SLP

Speech-Language Pathologist