Sandy A Jackson
Individual provider Active NPI Family Nurse Practitioner · Cuba, NY
NPI 1043671530 · NPPES record last updated Mar 29, 2017
Key facts
- NPI
- 1043671530
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 340897 (NY)
- Practice address
- 14 Center St
Cuba, NY 14727-1002 - Phone
- (585) 968-3210
- NPI assigned
- Mar 11, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 13
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Olean Medical Practice PLLC
Practice addresses (Care Compare)
14 Ctr St
Cuba, NY 14727-1002
Phone (585) 986-3210
Hospital & facility affiliations
- Vna of Western Ny Chha
- Willcare Chha (Buffalo)
- Jones Memorial Hospital
- Olean General Hospital
- Kaleida Health
- Cuba Memorial Hospital, Inc
- St James Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161108001490 | NY | Practitioner - Nurse Practitioner | 9032498498 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 501034 | NY | MD | Registered Nurse |
| 340897 | NY | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| General Physician, PC | Current |
Accepting new patients | |
| General Physician, PC | Current |
Accepting new patients | |
| Olean Medical Practice PLLC | Current | 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 340897 | NY | Yes |
| 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
Other providers in Cuba, NY
- Rajan Gulati
- James Edward Hanby
- David Michael Hanrahan
- Elizabeth Susan Hirsch
- Alinda Honey
- Kathryn Ellen Jefferies
- Eric Richard Jordan
- Erinne Lee Keim
- Dawn Ann Kelley-Cowher
- Kathryn Marie Knight
All providers in Cuba, NY · Family Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 29, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.