NPIMap

Individual provider Active NPI

Jennifer L Jackson, DO

  • Nephrology Physician
  • Dayton, OH
National Provider Identifier
1275507311
Registry record updated Oct 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
34007638 Issued in OH
Practice address
7700 Washington Village Dr
Suite 230
Dayton, OH 45459
Phone
(937) 438-3132
Fax
(937) 438-8707
NPI assigned
Feb 15, 2006
Last updated
Oct 12, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 34007638 OH Primary

Addresses

Primary practice location

7700 Washington Village Dr
Suite 230
Dayton, OH 45459

Mailing address

7700 Washington Village Dr
Suite 220
Dayton, OH 45459
Phone (937) 438-0099

Other identifiers 1

IdentifierTypeStateIssuer
2466291MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040617000001 OH Practitioner - NephrologyPractitioner - Internal Medicine 7618951542 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Ohio University, College of Osteopathic Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Renal Physicians IncGroup PAC ID 5193624161, 29 clinicians

Practice addresses (Care Compare)

455 Turner Rd
Dayton, OH 45415-3630
Phone (937) 496-5162

500 Lincoln Park Blvd
Suite 100
Dayton, OH 45429-6410

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Dayton Osteopathic Hospital CurrentSince Aug 1, 2004 Accepting new patients
Dayton Osteopathic Hospital CurrentSince Aug 1, 2004 Accepting new patients
Renal Physicians Inc Nephrology CurrentSince Apr 1, 2025 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

165 S Edwin C Moses Blvd
Dayton, OH 45402
Phone (937) 396-8150

1989 Miamisburg Centerville Rd
Ste 302
Dayton, OH 45459
Phone (937) 528-6890

455 Turner Rd
Dayton, OH 45415
Phone (937) 294-6711

7231 Shull Rd
Dayton, OH 45424
Phone (937) 235-2757

7700 Washington Village Dr
Ste 213
Dayton, OH 45459
Phone (934) 312-6540

7700 Washington Village Dr
Ste 230
Dayton, OH 45459
Phone (937) 438-0099

450B Washington Jackson Rd
Ste 107
Eaton, OH 45320
Phone (877) 645-9474

450C Washington Jackson Rd
Eaton, OH 45320
Phone (937) 235-2757

8701 Troy Pike
Ste 10
Huber Heights, OH 45424
Phone (937) 235-2757

500 Lincoln Park Blvd
Ste 100
Kettering, OH 45429
Phone (937) 222-3118

Organizations & group practices 5

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318377600000",
    "number": "1275507311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7700 WASHINGTON VILLAGE DR",
            "address_2": "SUITE 220",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "45459",
            "telephone_number": "937-438-0099",
            "fax_number": "937-438-0902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7700 WASHINGTON VILLAGE DR",
            "address_2": "SUITE 230",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "45459",
            "telephone_number": "937-438-3132",
            "fax_number": "937-438-8707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-15",
        "last_updated": "2011-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "OH",
            "license": "34007638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2466291",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.