Tiffany R Jackson, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704240163 Issued in MI

Practice address

1108 W State St
Suite 3
Hastings, MI 49058-9711

Phone

(269) 945-0922

Fax

(269) 945-4511

NPI assigned

Oct 1, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Tiffany Sparks Former name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Thornapple Valley Family Physicians PCGroup PAC ID 5698823250, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Corewell Health Pennock Hospital Hospital, Hastings, MI, CCN 231339
• Bronson Battle Creek Hospital Hospital, Battle Creek, MI, CCN 230075

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Interoperability endpoints

• Direct secure messaging: tiffanyjackson@tvfp.allscriptsdirect.net

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.

• Thornapple Valley Family Physicians PC

  • Family Medicine Physician
  • Hastings, MI
  • NPI 1528268513
  Medicare reassignment Care Compare group

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

• Bronson Battle Creek Hospital

  • General Acute Care Hospital
  • Battle Creek, MI
  • NPI 1083644579
  Care Compare affiliation
• Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation

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

{
    "created_epoch": "1349049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473724800000",
    "number": "1093066086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 W STATE ST",
            "address_2": "SUITE 3",
            "city": "HASTINGS",
            "state": "MI",
            "postal_code": "490589711",
            "telephone_number": "269-945-0922",
            "fax_number": "269-945-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TIFFANY",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-01",
        "last_updated": "2016-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704240163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "SPARKS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Della Lee Hughes Carter, DNP, G.N.P. - B.C.
• Makenna G Hughes
• Konnor Lyn Hunt, DC
• Taylor Rose Hurt, NP
• Internal Medicine Associates
• Elizabeth Jados
• James C. Peurach DDS, P.C.
• James L Weatherhead MD LLC
• Joseph Jandernoa
• Lauren Jansheski, LMSW, QIDP, QMHP

• Nurse Practitioner in Hastings, MI
• Providers in Hastings, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.