Clark Jackson

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

70693 Issued in NE

Practice address

2500 S 60TH St Apt 21
Lincoln, NE 68506-3579

Phone

(402) 613-2633

NPI assigned

May 20, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hypnos Anesthesia PCGroup PAC ID 1951320597, 8 clinicians

CHI Health Clinic Physician Enterprise-Anesthesia LLCGroup PAC ID 2264794569, 224 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• CHI Health Bergan Mercy Hospital, Omaha, NE, CCN 280060

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/7144/brand/1/csg/1/fhir/r4

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

• CHI Health Clinic Physician Enterprise-Anesthesia LLC

  • Anesthesiology Physician
  • Omaha, NE
  • NPI 1356858419

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Hypnos Anesthesia PC

  • Anesthesiology Physician
  • Omaha, NE
  • NPI 1699837682
  Medicare reassignment Care Compare group NPD
• Memorial Community Hospital Corporation

  • Critical Access Hospital
  • Blair, NE
  • NPI 1265408819
  Medicare reassignment NPD
• Metro Omaha Anesthesia PC

  • Anesthesiology Physician
  • Omaha, NE
  • NPI 1558884072
  Medicare reassignment NPD
• Northstar Anesthesia of Nebraska LLC

  • Anesthesiology Physician
  • Scottsbluff, NE
  • NPI 1578187670

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Orthoanesthesia, PC

  • Anesthesiology Physician
  • Omaha, NE
  • NPI 1184265274

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• St. Mary's Community Hospital

  dba CHI Health St. Mary's

  • Critical Access Hospital
  • Nebraska City, NE
  • NPI 1528016995
  Medicare reassignment NPD
• Urology Center PC

  dba Urohealth Partners

  • Urology Physician
  • Omaha, NE
  • NPI 1114919875
  Medicare reassignment NPD
• Memorial Community Hospital Corporation

  dba Cottonwood Clinic

  • Clinic/Center
  • Tekamah, NE
  • NPI 1437281623
  NPD
• Urology Center PC

  dba Urohealth Partners

  • Durable Medical Equipment & Medical Supplies
  • Fremont, NE
  • NPI 1851126643
  NPD
• CHI Health Clinic Specialty, LLC

  • Hospitalist Physician
  • Lincoln, NE
  • NPI 1285138065
  NPD (past)
• Hinners Geriatric Medicine, LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Omaha, NE
  • NPI 1841798477
  NPD (past)

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

• Alegent Health Bergan Mercy Health System

  dba Lasting Hope Recovery Center

  • Psychiatric Hospital Unit
  • Omaha, NE
  • NPI 1396969499
  Care Compare affiliation
• Alegent Health Bergan Mercy Health System

  dba CHI Health Creighton University Medical Center-Bergan Mercy

  • General Acute Care Hospital
  • Omaha, NE
  • NPI 1508941097
  Care Compare affiliation

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

{
    "created_epoch": "1463702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463702400000",
    "number": "1053768945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 S 60TH ST APT 21",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685063579",
            "telephone_number": "402-613-2633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 S 60TH ST APT 21",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685063579",
            "telephone_number": "402-613-2633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CLARK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-20",
        "last_updated": "2016-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NE",
            "license": "70693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyson Marie Jackson
• Anthony Jackson
• Ayana Jackson
• Christina Jackson
• Christina Michelle Jackson
• Destony Jackson
• Dontreal Jackson
• Erica Elizabeth Jackson, RD, LMNT
• Heather A Jackson, LIMHP, LPC
• Jaci Jackson

• Certified Registered Nurse Anesthetist in Lincoln, NE
• Providers in Lincoln, NE by specialty
• Certified Registered Nurse Anesthetist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.