NPIMap

Individual provider Active NPI

Katie Elizabeth Jackson, PA-C

  • Physician Assistant
  • Eldorado, IL
National Provider Identifier
1194077156
Registry record updated Dec 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085004431 Issued in IL
Practice address
1306 Maple Street
Ferrell Hospital Family Practice
Eldorado, IL 62930-1666
Phone
(618) 273-3361
NPI assigned
Oct 15, 2012
Last updated
Dec 3, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085004431 IL Primary

Addresses

Primary practice location

1306 Maple Street
Ferrell Hospital Family Practice
Eldorado, IL 62930-1666

Mailing address

1306 Maple Street
Ferrell Hospital Family Practice
Eldorado, IL 62930-1666
Phone (618) 273-3361

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20130613000292 IL Practitioner - Physician Assistant 9032358551 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

250 Small St
Harrisburg, IL 62946-3319
Phone (618) 294-8264

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.05 of 100Reported as apm
Quality
72.1
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ferrell Hospital Community Foundation Physician Assistant CurrentSince Mar 21, 2018 Accepting new patients
Ferrell Hospital Community Foundation Past Accepting new patients

Locations

1201 Pine St
Eldorado, IL 62930
Phone (618) 273-3361

1306 Maple St
Eldorado, IL 62930
Phone (618) 273-2360

250 Small St
Harrisburg, IL 62946
Phone (618) 252-4000

Interoperability endpoints

  • Direct secure messaging: kjackson73998@direct.deaconess.com

Organizations & group practices 3

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 6

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": "1350259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386028800000",
    "number": "1194077156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 MAPLE STREET",
            "address_2": "FERRELL HOSPITAL FAMILY PRACTICE",
            "city": "ELDORADO",
            "state": "IL",
            "postal_code": "629301666",
            "telephone_number": "618-273-3361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 MAPLE STREET",
            "address_2": "FERRELL HOSPITAL FAMILY PRACTICE",
            "city": "ELDORADO",
            "state": "IL",
            "postal_code": "629301666",
            "telephone_number": "618-273-3361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KATIE",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-15",
        "last_updated": "2013-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085004431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eldorado, IL

Sources for this page

Verify at the official NPI Registry.