Stephanie Brazeal Jackson, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN071218 Issued in GA

Practice address

711 Trestle Rd
Locust Grove, GA 30248-3465

Phone

(770) 914-5934

NPI assigned

Nov 21, 2007

Last updated

Jul 29, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Stephanie Cecilia Jackson Other name

Medicare fee-for-service enrollment

Enrolled in GA

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, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Piedmont Hospitalist Physicians LLCGroup PAC ID 1951299163, 503 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Piedmont Fayette Hospital Hospital, Fayetteville, GA, CCN 110215

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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.

• Piedmont Hospitalist Physicians LLC

  • Family Medicine Physician
  • Stockbridge, GA
  • NPI 1548219660
  Medicare reassignment Care Compare group NPD
• Coweta Emergency Group LLC

  • Emergency Medicine Physician
  • Newnan, GA
  • NPI 1245556588
  Medicare reassignment NPD
• Georgia Emergency Group, LLC

  • Emergency Medicine Physician
  • Griffin, GA
  • NPI 1952746638
  Medicare reassignment NPD
• Apollomd Group Services, LLC

  • Anesthesiology Physician
  • Griffin, GA
  • NPI 1568616860
  NPD (past)
• Inphynet Primary Care Physicians Southeast PC

  • Emergency Medicine Physician
  • Columbus, GA
  • NPI 1770521460
  NPD (past)
• Acs Primary Care Physicians - Southeast PC

  • Emergency Medicine Physician
  • Myrtle Beach, SC
  • NPI 1861430555
  NPD (past)

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

• Fayette Community Hospital, Inc.

  dba Piedmont Fayette Hospital

  • General Acute Care Hospital
  • Fayetteville, GA
  • NPI 1528027240
  Care Compare affiliation

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

{
    "created_epoch": "1195603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438128000000",
    "number": "1255512984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 TRESTLE RD",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302483465",
            "telephone_number": "770-914-5934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 TRESTLE RD",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302483465",
            "telephone_number": "770-914-5934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "STEPHANIE",
        "middle_name": "BRAZEAL",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-21",
        "last_updated": "2015-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN071218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "JACKSON",
            "middle_name": "CECILIA",
            "prefix": "MRS.",
            "credential": "NP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Jep Healthcare Inc.

• Family Nurse Practitioner in Locust Grove, GA
• Providers in Locust Grove, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2015; 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.