NPIMap

Individual provider Active NPI

Nicholas Jackson

  • Surgery Physician
  • Louisville, KY
National Provider Identifier
1205298387
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
R4098 Issued in KY
Practice address
1000 Dupont Rd
Louisville, KY 40207-4611
Phone
(502) 899-6150
NPI assigned
Mar 28, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X R4098 KY Primary

Addresses

Primary practice location

1000 Dupont Rd
Louisville, KY 40207-4611

Mailing address

1000 Dupont Rd
Louisville, KY 40207-4611
Phone (502) 899-6150

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, KY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210820001598 IN Practitioner - General Surgery 0547530503 Reassigns benefits to 1 organization
I20210820003122 KY Practitioner - General Surgery 0547530503 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Kentucky College of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Medical Associates IncGroup PAC ID 7012811284, shared by 2 NPIs, 1,368 clinicians

Practice addresses (Care Compare)

1000 Dupont Rd
Suite a
Louisville, KY 40207-4611
Phone (502) 899-6150

1373 E State Rd
Madison, IN 47250-7328
Phone (812) 801-0840

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.11 of 100Reported as group
Quality
63.34
Promoting interoperability
100
Improvement activities
40
Cost
73.68

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy14
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical Associates, Inc. Current Accepting new patients
Community Medical Associates, Inc. Current Accepting new patients
Community Medical Associates, Inc. CurrentSince Sep 1, 2021 Accepting new patients

Locations

2051 Clevidence Blvd
Clarksville, IN 47129
Phone (812) 280-6650

1263 Hospital Dr NW
Ste 210
Corydon, IN 47112
Phone (502) 636-7242

1141 Hospital Dr NW
Ste 100
Corydon, IN 47112
Phone (502) 891-8575

1373 E State Road 62
Ste 2C
Madison, IN 47250
Phone (812) 801-0840

4123 Dutchmans Ln
Ste 607
Louisville, KY 40207
Phone (502) 899-6470

315 E Broadway
Ste 310A
Louisville, KY 40202
Phone (502) 899-6150

825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165

315 E Broadway
Ste 310
Louisville, KY 40202
Phone (502) 629-2610

1000 DuPont Rd
Louisville, KY 40207
Phone (502) 899-6405

1000 DuPont Rd
Ste A
Louisville, KY 40207
Phone (502) 899-6150

850 S 28th St
Ste 104
Louisville, KY 40211
Phone (502) 394-5678

Interoperability endpoints

  • Direct secure messaging: njackson24313@ukhcdirect.org
  • Direct secure messaging: njackson214483@direct.nortonhealthcare.org

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 and National Provider Directory roles.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1459123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1205298387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 DUPONT RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074611",
            "telephone_number": "502-899-6150",
            "fax_number": "502-891-6368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 DUPONT RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074611",
            "telephone_number": "502-899-6150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NICHOLAS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-28",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "KY",
            "license": "R4098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.