Jaclynn A Jackubowski, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704362045 Issued in MI

Practice address

1234 Napier Ave
Saint Joseph, MI 49085-2112

Phone

(269) 982-5864

NPI assigned

Sep 29, 2013

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

Medicare fee-for-service enrollment

Enrolled in MI

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, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Lakeland Medical PracticesGroup PAC ID 1658427042, 286 clinicians

Lakeland Hospitals at Niles and St Joseph IncGroup PAC ID 7517929037, 134 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021
• Corewell Health Watervliet Hospital Hospital, Watervliet, MI, CCN 230078

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jjackubowski1270079@epic00.corewelldirect.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lakeland Hospitals at Niles and St Joseph, Inc

  dba Corewell Health Lakeland Hospitals

  • General Acute Care Hospital
  • Saint Joseph, MI
  • NPI 1134220031
  Medicare reassignment Care Compare group NPD
• Lakeland Medical Practices

  dba Corewell Health Medical Group South

  • Internal Medicine Physician
  • Saint Joseph, MI
  • NPI 1538397120
  Medicare reassignment Care Compare group NPD
• Lakeland Hospitals at Niles and St Joseph, Inc

  dba Corewell Health Lakeland Hospitals (MDPP)

  • Community Health Clinic/Center
  • Saint Joseph, MI
  • NPI 1184513731
  NPD
• Lakeland Medical Practices

  dba Corewell Health Medical Group South

  • Internal Medicine Physician
  • Bridgman, MI
  • NPI 1568232247
  NPD
• Vein Clinics of Chicago LLC

  • Vascular Surgery Physician
  • Chicago, IL
  • NPI 1386904621
  NPD (past)

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

• Lakeland Community Hospital Watervliet

  dba Corewell Health Watervliet Hospital

  • General Acute Care Hospital
  • Watervliet, MI
  • NPI 1700994845
  Care Compare affiliation
• Lakeland Hospitals at Niles and St Joseph, Inc

  dba Corewell Health Lakeland Hospitals

  • General Acute Care Hospital
  • Saint Joseph, MI
  • NPI 1134220031
  Care Compare affiliation

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

{
    "created_epoch": "1380412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1427485945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1234 NAPIER AVE",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490852112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1234 NAPIER AVE",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490852112",
            "telephone_number": "269-982-5864"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4789 Route 71",
            "address_purpose": "LOCATION",
            "city": "Oswego",
            "state": "IL",
            "postal_code": "605437415",
            "country_code": "US",
            "telephone_number": "630-692-5730",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKUBOWSKI",
        "first_name": "JACLYNN",
        "middle_name": "A",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-29",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209010632",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704362045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Initium Physical Therapy and Sports Performance LLC
• Innovative Senior Care Home Health of Holland LLC (Brookdale Home Health Holland)
• Amena Iqbal
• Kevin Rojeh Ismair, D.O.
• Kaitlyn Jackson
• Julie Ann Jacobs, P.A.
• Melissa Jacobs, FNP-C
• Rebecca R Jacobs
• Stacey Lynne Jacobs, RDH
• John Jaeger

• Nurse Practitioner in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.