Active NPI
Mackenzie Jacobson
- Nurse Practitioner
- Lancaster, OH
National Provider Identifier
1063949790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 020843
- Practice address
- 1550 Sheridan Dr
202
Lancaster, OH 43130-1381 - Phone
- (740) 654-0232
- NPI assigned
- May 12, 2017
- Last updated
- May 12, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 020843 | OH | Primary |
Addresses
Primary practice location
1550 Sheridan Dr
202
Lancaster, OH 43130-1381
Mailing address
638 E 5TH Ave
Lancaster, OH 43130-3107
Phone (740) 304-9309
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Access Medical Group LLC | Past | Accepting new patients | |
| Meritra Physicians LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
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- Marion, OH
- NPI 1295900827
-
- Hospitalist Physician
- Marion, OH
- NPI 1629552203
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494547200000",
"number": "1063949790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "638 E 5TH AVE",
"city": "LANCASTER",
"state": "OH",
"postal_code": "431303107",
"telephone_number": "740-304-9309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1550 SHERIDAN DR",
"address_2": "202",
"city": "LANCASTER",
"state": "OH",
"postal_code": "431301381",
"telephone_number": "740-654-0232"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSON",
"first_name": "MACKENZIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-12",
"last_updated": "2017-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "OH",
"license": "020843",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lancaster, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.