NPIMap

Individual provider Active NPI

Jessica Renea Tackett, D.O.

  • Family Medicine Physician
  • Greenbrier, AR
National Provider Identifier
1346509478
Registry record updated Sep 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
E9071 Issued in AR
Practice address
49 S Broadview St Ste 1
Greenbrier, AR 72058-8011
Phone
(501) 679-4030
NPI assigned
May 9, 2012
Last updated
Sep 29, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X E9071 AR Primary

Addresses

Primary practice location

49 S Broadview St Ste 1
Greenbrier, AR 72058-8011

Mailing address

49 S Broadview St Ste 1
Greenbrier, AR 72058-8011
Phone (501) 679-4030

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20150713002209 AR Practitioner - Family Practice 8527371046 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Kansas City College of Medicine and Surgery, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bowlin-Cummins PAGroup PAC ID 5698725745, 8 clinicians
Arkansas Health GroupGroup PAC ID 7911802079, 645 clinicians

Practice addresses (Care Compare)

2425 Dave Ward Dr
Suite 401
Conway, AR 72034-8681
Phone (501) 329-3824

49 S Broadview St
Suite 1
Greenbrier, AR 72058-8011
Phone (501) 679-4030

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E9071ARMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ozark Health, Inc CurrentSince Oct 28, 2017 Accepting new patients
Arkansas Health Group Family Medicine CurrentSince Aug 1, 2015 Accepting new patients
Ozark Health, Inc CurrentSince Oct 28, 2017 Accepting new patients
Arkansas Health Group CurrentSince Aug 1, 2015 Accepting new patients
Arkansas Health Group Family Medicine Past Accepting new patients

Locations

2500 Highway 65 S
Clinton, AR 72031
Phone (501) 745-7000

49 S Broadview St
Ste 1
Greenbrier, AR 72058
Phone (501) 679-4030

11001 Executive Center Dr
Ste 200
Little Rock, AR 72211
Phone (501) 812-7215

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/ozarkh-5b939301
  • Direct secure messaging: jtackett119125@direct.baptist-healthar.org

Organizations & group practices 6

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1336521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443484800000",
    "number": "1346509478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 S BROADVIEW ST STE 1",
            "city": "GREENBRIER",
            "state": "AR",
            "postal_code": "720588011",
            "telephone_number": "501-679-4030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 S BROADVIEW ST STE 1",
            "city": "GREENBRIER",
            "state": "AR",
            "postal_code": "720588011",
            "telephone_number": "501-679-4030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKETT",
        "first_name": "JESSICA",
        "middle_name": "RENEA",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-09",
        "last_updated": "2015-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E9071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenbrier, AR

Sources for this page

Verify at the official NPI Registry.