Stephanie A. Jackovich, NP

Primary specialty

Neonatal Nurse PractitionerTaxonomy code 363LN0000X

License

71003307 Issued in IN

Practice address

705 Riley Hospital Dr
RR 208
Indianapolis, IN 46202-5109

Phone

(317) 274-4715

Fax

(317) 274-2065

NPI assigned

Aug 11, 2010

Last updated

Dec 7, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ, TX2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: swellsand46536@direct.valleywisehealth.org

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.

• Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm

  dba Phoenix Indian Medical Center

  • Public Health or Welfare Agency
  • Phoenix, AZ
  • NPI 1083643738

  TX

  Medicare reassignment NPD
• Maricopa County Special Health Care District

  dba Valleywise Health

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1073576740
  Medicare reassignment NPD
• Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm

  dba Ak-Chin Clinic

  • Public Health or Welfare Agency
  • Maricopa, AZ
  • NPI 1538043443
  NPD
• Maricopa County Special Health Care District

  dba Maricopa Integrated Heatlh

  • Federally Qualified Health Center (FQHC)
  • Mesa, AZ
  • NPI 1306265145
  NPD
• University Pediatric Associates, Inc.

  • Pediatrics Physician
  • Indianapolis, IN
  • NPI 1457396541

  Nurse Practitioner

  NPD (past)
• Obstetrix Medical Group of Phoenix PC

  dba Phoenix Perinatal Associates

  • Neonatal-Perinatal Medicine Physician
  • Mesa, AZ
  • NPI 1407957152
  NPD (past)

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

{
    "created_epoch": "1281484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701907200000",
    "number": "1265747570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1026",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462061026",
            "telephone_number": "317-274-1201",
            "fax_number": "317-278-9905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 RILEY HOSPITAL DR",
            "address_2": "RR 208",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462025109",
            "telephone_number": "317-274-4715",
            "fax_number": "317-274-2065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKOVICH",
        "first_name": "STEPHANIE",
        "middle_name": "A.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-11",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "IN",
            "license": "28164413",
            "primary": false
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "IN",
            "license": "71003307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201040340",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sherwin Jack, PHD
• Brandon Jackett, RBT
• Kate Jackett
• Jackie's Home Care PCS
• Christopher Thomas Jackman, MD
• Ebony Jacks
• Cahlil Michael Jackson-Chapple
• Jennifer Jackson-Harr, LCSW
• Adalyn Jackson
• Adriaka Y Jackson, MS

• Neonatal Nurse Practitioner in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Neonatal Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.