Active NPI
Ramona Lee Jackson
- Personal Care Attendant
- Grand Forks, ND
National Provider Identifier
1104491430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Personal Care Attendant
- Practice address
- 1108 N 39TH St Apt 2
Grand Forks, ND 58203 - Phone
- (701) 213-0990
- NPI assigned
- May 20, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Personal Care Attendant | 3747P1801X | ND | Primary |
Addresses
Primary practice location
1108 N 39TH St Apt 2
Grand Forks, ND 58203
Mailing address
1204 N 39TH St Apt 4
Grand Forks, ND 58203
Phone (701) 213-0990
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ND4695230 | Medicaid | ND |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621468800000",
"number": "1104491430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1204 N 39TH ST APT 4",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "58203",
"telephone_number": "701-213-0990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1108 N 39TH ST APT 2",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "58203",
"telephone_number": "701-213-0990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "RAMONA",
"middle_name": "LEE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-20",
"last_updated": "2021-05-20",
"certification_date": "2021-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "3747P1801X",
"taxonomy_group": "",
"desc": "Technician, Personal Care Attendant",
"state": "ND",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ND4695230",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Forks, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.