NPIMap

Individual provider Active NPI

Nicola Natasha Jackson, MD

  • Rheumatology Physician
  • Crestview Hills, KY
National Provider Identifier
1003470311
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
58883 Issued in KY
Practice address
651 Centre View Blvd
Crestview Hills, KY 41017-5419
Phone
(859) 344-1900
Fax
(859) 344-4632
NPI assigned
Apr 23, 2019
Reactivated
Dec 27, 2019
Last updated
Jul 1, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Rheumatology Physician 207RR0500X 58883 KY Primary

Addresses

Primary practice location

651 Centre View Blvd
Crestview Hills, KY 41017-5419

Mailing address

PO Box 635283
Cincinnati, OH 45263-5283
Phone (859) 344-1900

Other practice location 1

1270 Prince Avenue
Suite 201
Athens, GA 30606
Phone (706) 475-7055

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240903001169 KY Practitioner - Rheumatology 6406395508 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Rheumatology
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Summit Medical Group IncGroup PAC ID 2163326240, 803 clinicians

Practice addresses (Care Compare)

651 Centre View Boulvard
Crestview Hills, KY 41017-5419
Phone (859) 331-6466

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, Inc CurrentSince Jul 31, 2024 Accepting new patients
Summit Medical Group, Inc Current Accepting new patients
Summit Medical Group, Inc. CurrentSince Jul 31, 2024 Accepting new patients

Locations

651 Centre View Blvd
Crestview Hills, KY 41017
Phone (859) 341-6660

1980 Litton Ln
Hebron, KY 41048
Phone (859) 334-8700

300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217

Networks

  • KY PPO C-SNP
  • OH PPO
  • devoted network organization-598bd2d4-c652-473f-ba7a-132f674c8eb6
  • KY PPO
  • TN PPO
  • TN PPO C-SNP

Interoperability endpoints

  • Direct secure messaging: njackson425560@direct-prd.stelizabeth.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1003470311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635283",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452635283",
            "telephone_number": "859-344-1900",
            "fax_number": "859-344-4632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 CENTRE VIEW BLVD",
            "city": "CRESTVIEW HILLS",
            "state": "KY",
            "postal_code": "410175419",
            "telephone_number": "859-344-1900",
            "fax_number": "859-344-4632"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1270 Prince Avenue",
            "address_2": "Suite 201",
            "address_purpose": "LOCATION",
            "city": "Athens",
            "state": "GA",
            "postal_code": "30606",
            "country_code": "US",
            "telephone_number": "706-475-7055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NICOLA",
        "middle_name": "NATASHA",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-23",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "deactivation_date": "2019-12-04",
        "reactivation_date": "2019-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "KY",
            "license": "58883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview Hills, KY

Sources for this page

Verify at the official NPI Registry.