NPIMap

Individual provider Active NPI

Sandy A Jackson

  • Family Nurse Practitioner
  • Cuba, NY
National Provider Identifier
1043671530
Registry record updated Mar 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
340897 Issued in NY
Practice address
14 Center St
Cuba, NY 14727-1002
Phone
(585) 968-3210
NPI assigned
Mar 11, 2016
Last updated
Mar 29, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 29, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 340897 NY Primary
Registered Nurse 163W00000X 501034 NY

Addresses

Primary practice location

14 Center St
Cuba, NY 14727-1002

Mailing address

47 Rochambeau Avenue Ext
Andover, NY 14806-9606

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20161108001490 NY Practitioner - Nurse Practitioner 9032498498 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Olean Medical Practice PLLCGroup PAC ID 0042698045, 56 clinicians

Practice addresses (Care Compare)

14 Ctr St
Cuba, NY 14727-1002
Phone (585) 986-3210

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
501034NYMDRegistered Nurse
340897NYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
General Physician, PC CurrentSince Jun 1, 2022 Accepting new patients
Olean Medical Practice PLLC Current Accepting new patients
General Physician, PC CurrentSince Jun 1, 2022 Accepting new patients
General Physician, PC Past Accepting new patients

Locations

14 Center St
Cuba, NY 14727
Phone (585) 968-3210

535 Main St
Olean, NY 14760
Phone (716) 372-0141

535 Main St
Ste 1
Olean, NY 14760
Phone (716) 372-0141

Organizations & group practices 4

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1457654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490745600000",
    "number": "1043671530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 ROCHAMBEAU AVENUE EXT",
            "city": "ANDOVER",
            "state": "NY",
            "postal_code": "148069606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 CENTER ST",
            "city": "CUBA",
            "state": "NY",
            "postal_code": "147271002",
            "telephone_number": "585-968-3210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SANDY",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-11",
        "last_updated": "2017-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "340897",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "501034",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cuba, NY

Sources for this page

Verify at the official NPI Registry.