Individual provider Active NPI

Mary Sheree Jackson

  • Home Health Aide
  • Munhall, PA
National Provider Identifier
1194388678
Registry record updated May 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AideTaxonomy code 374U00000X
License
39723601 Issued in PA
Practice address
310 Eliabeth Street
Munhall, PA 15120-3314
Phone
(412) 805-4652
NPI assigned
Apr 19, 2019
Last updated
May 22, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Aide 374U00000X 39723601 PA Primary

Addresses

Primary practice location

310 Eliabeth Street
Munhall, PA 15120-3314

Mailing address

310 Elizabeth St
Munhall, PA 15120-3314
Phone (412) 805-4652

Other identifiers 1

IdentifierTypeStateIssuer
39723601MedicaidPA

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

State licenses

LicenseStateTypeSpecialty
39723601PAMDHome Health Aide

Practice roles

OrganizationSpecialtyStatusNew patients
Leann's Loving Hands Home Care Single Specialty CurrentSince Jul 21, 2024 Accepting new patients
Leann's Loving Hands Home Care of Ohio Home Health Aide Current Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1555632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716336000000",
    "number": "1194388678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 ELIZABETH ST",
            "city": "MUNHALL",
            "state": "PA",
            "postal_code": "151203314",
            "telephone_number": "412-805-4652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 ELIABETH STREET",
            "city": "MUNHALL",
            "state": "PA",
            "postal_code": "151203314",
            "telephone_number": "412-805-4652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARY",
        "middle_name": "SHEREE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-19",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "PA",
            "license": "39723601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39723601",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Munhall, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.