Brent Jackson

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

210172 Issued in OK

Practice address

2377 County Road 1201
Tuttle, OK 73089-1067

Phone

(405) 412-3213

NPI assigned

Aug 6, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Merit-based Incentive Payment System (MIPS)

Final score

96.74 of 100Reported as group

Quality

80.2

Promoting interoperability

100

Improvement activities

40

Cost

76.39

Merit-based Incentive Payment System (MIPS)

Final score

89.42 of 100Reported as group

Quality

76.28

Promoting interoperability

100

Improvement activities

30

Cost

76.08

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bjackson678797@hisp.ehr.sutterhealth.org

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.

• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Santa Rosa, CA
  • NPI 1740413798

  CA

  Medicare reassignment NPD
• Sutter Bay Hospitals

  • Rehabilitation Hospital Unit
  • Oakland, CA
  • NPI 1194171371
  NPD
• Sutter Bay Hospitals

  • General Acute Care Hospital
  • San Francisco, CA
  • NPI 1740348929
  NPD

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

{
    "created_epoch": "1659744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662249600000",
    "number": "1245967405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2377 COUNTY ROAD 1201",
            "city": "TUTTLE",
            "state": "OK",
            "postal_code": "730891067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2377 COUNTY ROAD 1201",
            "city": "TUTTLE",
            "state": "OK",
            "postal_code": "730891067",
            "telephone_number": "405-412-3213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRENT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-06",
        "last_updated": "2022-09-04",
        "certification_date": "2022-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OK",
            "license": "96391",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "OK",
            "license": "210172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miranda High
• Lyle Kent Hinds, D.PH.
• Elisa Huber
• Wayne A Huey, DO
• Incipient Care Inc.
• Timber Laine Jackson, FNP-C
• Thomas Alan Jarvis, D.O.
• Jerry D McCan DDS
• Carl Lee Laffoon, ARNP
• Michele Lynne Lange, ARNP

• All providers in Tuttle, OK
• Acute Care Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2022; 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.