NPIMap

Individual provider Active NPI

Jacob Jackson, APRN, CNP

  • Family Nurse Practitioner
  • Elk City, OK
National Provider Identifier
1134629405
Registry record updated Mar 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
113330 Issued in OK
Practice address
1800 W 1St St Ste 105B
Elk City, OK 73644-3133
Phone
(580) 225-2518
Fax
(580) 225-3167
NPI assigned
Feb 13, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 113330 OK Primary
Medical-Surgical Registered Nurse 163WM0705X 113330 OK

Addresses

Primary practice location

1800 W 1St St Ste 105B
Elk City, OK 73644-3133

Mailing address

PO Box 2339
Elk City, OK 73648-2339
Phone (580) 225-2518

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180426001863 OK Practitioner - Nurse Practitioner 4082978143 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Michael Robinson Medical Clinic, LLCGroup PAC ID 2365689593, 2 clinicians

Practice addresses (Care Compare)

1800 W 1St St
Elk City, OK 73644-3133

1801 W 3Rd St
Elk City, OK 73644-5145
Phone (580) 225-2511

1819 W 3Rd St
Great Plains Regional Medical Center
Elk City, OK 73644-5145
Phone (580) 225-2511

1900 W
2ND Suite a
Elk City, OK 73644-4328
Phone (580) 303-9060

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
113330OKMDMedical-Surgical Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Farmers Union Hospital Association CurrentSince Mar 11, 2020 Accepting new patients
Michael Robinson Medical Clinic, LLC CurrentSince May 17, 2022 Accepting new patients
Farmers Union Hospital Association CurrentSince Mar 11, 2020 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients

Locations

1801 W 3rd St
Elk City, OK 73644
Phone 5802255403677

1800 W 1st St
Ste 3
Elk City, OK 73644
Phone (580) 225-4699

1900 W 2nd St
Ste A
Elk City, OK 73644
Phone (580) 225-2663

1505 Watts St
Sayre, OK 73662
Phone (580) 928-0237

Interoperability endpoints

  • Direct secure messaging: jacob.jackson@gprmc.eclinicaldirectplus.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/JBAEBA

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1518480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585180800000",
    "number": "1134629405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2339",
            "city": "ELK CITY",
            "state": "OK",
            "postal_code": "736482339",
            "telephone_number": "580-225-2518",
            "fax_number": "580-225-3167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 W 1ST ST STE 105B",
            "city": "ELK CITY",
            "state": "OK",
            "postal_code": "736443133",
            "telephone_number": "580-225-2518",
            "fax_number": "580-225-3167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JACOB",
        "credential": "APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-13",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "113330",
            "primary": true
        },
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "OK",
            "license": "113330",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk City, OK

Sources for this page

Verify at the official NPI Registry.