Individual provider Active NPI

Yvonne Woodford Jackson, CRNA

  • Certified Registered Nurse Anesthetist
  • Canton, OH
National Provider Identifier
1104853837
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN169055 Issued in OH
Practice address
2600 Sixth Street SW
Ohio Hospital Based Physician Corp
Canton, OH 44710
Phone
(330) 363-7462
Fax
(330) 363-7679
NPI assigned
Jun 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN169055 OH Primary

Addresses

Primary practice location

2600 Sixth Street SW
Ohio Hospital Based Physician Corp
Canton, OH 44710

Mailing address

2600 Sixth Street SW
Ohio Hospital Based Physician Corp
Canton, OH 44710
Phone (330) 363-7462

Other identifiers 1

IdentifierTypeStateIssuer
0887090MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
80.19 of 100Reported as group
Quality
63.25
Promoting interoperability
98
Improvement activities
40
Cost
72.4

Merit-based Incentive Payment System (MIPS)

Final score
85.62 of 100Reported as group
Quality
77.5
Promoting interoperability
100
Improvement activities
40
Cost
74.58

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN169055OHMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Aultman Deuble Heart & Vascular Hospital, LLC CurrentSince Jan 6, 2020 Accepting new patients

Locations

2600 6th St SW
Canton, OH 44710
Phone (330) 363-2180

2600 6th St SW
Ste A2800
Canton, OH 44710

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104853837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 SIXTH STREET SW",
            "address_2": "OHIO HOSPITAL BASED PHYSICIAN CORP",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "44710",
            "telephone_number": "330-363-7462",
            "fax_number": "330-363-7679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 SIXTH STREET SW",
            "address_2": "OHIO HOSPITAL BASED PHYSICIAN CORP",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "44710",
            "telephone_number": "330-363-7462",
            "fax_number": "330-363-7679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "YVONNE",
        "middle_name": "WOODFORD",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "RN169055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0887090",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.