Shavonne Jackson, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024185612 Issued in VA

Practice address

524 Southpark Blvd
Colonial Heights, VA 23834-3609

Phone

(804) 504-7980

Fax

(804) 554-5387

NPI assigned

Dec 6, 2022

Last updated

Jul 10, 2024By 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 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA

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, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PMR Virginia Holding LLCGroup PAC ID 9537576608, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/AAJACD

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.

• PMR Virginia Holding, LLC

  dba Jencare Senior Medical Centers of Virginia

  • Specialist
  • Miami Gardens, FL
  • NPI 1083167001

  VA

  Medicare reassignment Care Compare group NPD
• Woodruff Residential LLC

  • Developmentally Disabled Services Day Training Agency
  • North Chesterfield, VA
  • NPI 1255143681
  NPD Authorized official
• Jencare Neighborhood Medical South Park LLC

  dba JenCare Neighborhood Medical Centers

  • Non-Pharmacy Dispensing Site
  • Colonial Heights, VA
  • NPI 1134489214
  NPD
• Advanced Arthritis and Rheumatology Care, PC

  • Rheumatology Physician
  • Midlothian, VA
  • NPI 1922366012
  NPD (past)
• Jencare Neighborhood Medical East Richmond, LLC

  dba JenCare Neighborhood MedicalEast Richmond

  • Internal Medicine Physician
  • Richmond, VA
  • NPI 1891089454
  NPD (past)

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

{
    "created_epoch": "1670284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1356052971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 SOUTHPARK BLVD",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238343609",
            "telephone_number": "804-504-7980",
            "fax_number": "804-554-5387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 SOUTHPARK BLVD",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238343609",
            "telephone_number": "804-504-7980",
            "fax_number": "804-554-5387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SHAVONNE",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-06",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024185612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "midatlantickidney@directaddress.net",
            "affiliation": "N",
            "endpointDescription": "midatlantickidney@directaddress.net",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4575 Whitehill Blvd Ste 101",
            "city": "Prince George",
            "state": "VA",
            "country_code": "US",
            "postal_code": "238751273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Yorckay Chang Ishizawar, M.D.
• Claire Emma Jackson
• Derrell Glenn Jackson, PA-C
• Rebecca Jackson, M.S., CCC-SLP
• Sarah C Jackson, LCSW, CSAC
• Tonya Tonique Jackson, APRN
• Harvinder S Jagait, MD
• James River Cardiology, LLC (Colonial Heart)
• Slawomir Paul Jarzabek
• Jencare Neighborhood Medical South Park LLC (JenCare Neighborhood Medical Centers)

• Family Nurse Practitioner in Colonial Heights, VA
• Providers in Colonial Heights, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; 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.