Catherine Alisa Jackson

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

APRN.CNP.0034084 Issued in OH

Practice address

3535 Southern Blvd
Kettering, OH 45429-1221

Phone

(937) 298-4331

NPI assigned

Jun 19, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in OH

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, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Namchi Le MD LLCGroup PAC ID 6901167501, 4 clinicians

Wound Care Consultants LLCGroup PAC ID 2567646359, 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Miami Valley Hospital Hospital, Dayton, OH, CCN 360051

Merit-based Incentive Payment System (MIPS)

Final score

81.34 of 100Reported as group

Quality

63.67

Promoting interoperability

100

Improvement activities

40

Cost

74.14

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Namchi Le MD LLC

  • Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
  • Dayton, OH
  • NPI 1518486653
  Medicare reassignment Care Compare group NPD
• Wound Care Consultants LLC

  • Foot & Ankle Surgery Podiatrist
  • Parma, OH
  • NPI 1831495373

  Gerontology

  Medicare reassignment Care Compare group NPD
• Kettering Independent Medical Group Inc

  • Orthopaedic Surgery Physician
  • Miamisburg, OH
  • NPI 1629387865
  Medicare reassignment NPD
• Caremed Ohio LLC

  • Multi-Specialty Clinic/Center
  • Kenton, OH
  • NPI 1669123949
  Medicare reassignment
• Alliance Physicians Inc

  • Family Medicine Physician
  • Kettering, OH
  • NPI 1437125572
  NPD

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

• Miami Valley Hospital

  • General Acute Care Hospital
  • Dayton, OH
  • NPI 1073688354
  Care Compare affiliation

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

{
    "created_epoch": "1687132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1215612031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 SOUTHERN BLVD",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291221",
            "telephone_number": "937-298-4331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 SOUTHERN BLVD",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291221",
            "telephone_number": "937-298-4331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CATHERINE",
        "middle_name": "ALISA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-19",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OH",
            "license": "APRN.CNP.0034084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "3535 Southern Blvd",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291221",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cjackson889919@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3535 Southern Blvd",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454291221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Blythe Isenburg
• Ashelyne Islas
• Susan M Iwinski, MA, LPCC
• J Clarke Sanders DDS Kettering LLC
• J&W Surgical Services LLC
• Macia L Jackson, RNFA, CNOR
• Sarah Elizabeth Jackson, DO
• Akira Jacobs
• Edward Cornelious Jacobs, M.D.
• Martin P Jacobs, MD

• Gerontology Nurse Practitioner in Kettering, OH
• Providers in Kettering, OH by specialty
• Gerontology Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; 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.