Mary Jackson

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

132732 Issued in OK

Practice address

5201 Harry Hines Blvd
Dallas, TX 75235-7708

Phone

(214) 590-8000

NPI assigned

Feb 12, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeast Texas Intensivists, PLLCGroup PAC ID 7810342672, 37 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Christus Southeast Texas- St Elizabeth Hospital, Beaumont, TX, CCN 450034

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mjackson156299@christushealth.direct-ci.net
• Direct secure messaging: mjackson393659@directhoustonmethodist.org
• Direct secure messaging: mjackson355800@ahs.direct-ci.com

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.

• Southeast Texas Intensivists, PLLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Beaumont, TX
  • NPI 1801579867
  Medicare reassignment Care Compare group NPD
• Christus Trinity Clinic Texas

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1285684225
  Medicare reassignment NPD
• Ess of Nacogdoches LLC

  • Emergency Medicine Physician
  • Nacogdoches, TX
  • NPI 1780139956
  Medicare reassignment NPD
• Christus Trinity Clinic Texas

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1801673165
  NPD

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

• Christus Health Southeast Texas

  • General Acute Care Hospital
  • Beaumont, TX
  • NPI 1679557888
  Care Compare affiliation

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

{
    "created_epoch": "1423699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567468800000",
    "number": "1124419015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 WALL ST",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749534433",
            "telephone_number": "918-635-3566",
            "fax_number": "918-635-3308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 HARRY HINES BLVD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752357708",
            "telephone_number": "214-590-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-12",
        "last_updated": "2019-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "OK",
            "license": "132732",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "AP127185",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsey Marie Jackson
• Lisa Jackson
• Marcus Jackson
• Maria O. Jackson, D.D.S.
• Marilyn Renee Jackson, LPC-S
• Meredith Jackson, MD
• Morya Koquese Jackson
• Nancy Angelia Jackson, MS-CCC/SLP
• Nancy Jo Jackson, PA-C
• Nathaniel Jackson, L.P.C.

• Acute Care Nurse Practitioner in Dallas, TX
• Providers in Dallas, TX by specialty
• Acute Care Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2019; 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.