Kimberly Nicole Jackson, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

34.011422 Issued in OH

Practice address

2581 North Rd NE
Warren, OH 44483-3052

Phone

(234) 287-6802

Fax

(330) 372-4437

NPI assigned

Oct 24, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Ohio University, College of Osteopathic Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Triad Health Services LLCGroup PAC ID 9032367917, 252 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Surgical Hospital at Southwoods Hospital, Youngstown, OH, CCN 360352

Merit-based Incentive Payment System (MIPS)

Final score

83.94 of 100Reported as group

Quality

71.12

Promoting interoperability

100

Improvement activities

40

Cost

75.36

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

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

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.

• Triad Health Services, LLC

  • Plastic Surgery Physician
  • Youngstown, OH
  • NPI 1588925457

  Family Medicine

  Medicare reassignment Care Compare group NPD
• 4M Emergency Systems Tod LLC

  • Emergency Medicine Physician
  • Warren, OH
  • NPI 1902859556
  Medicare reassignment NPD
• River Valley Physicians, LLC

  • Multi-Specialty Clinic/Center
  • East Liverpool, OH
  • NPI 1891756870
  Medicare reassignment NPD
• Mercy Health Youngstown LLC

  • Durable Medical Equipment & Medical Supplies
  • Youngstown, OH
  • NPI 1245180785
  NPD (past)
• The Surgery Center at Southwoods, LLC

  • Special Hospital
  • Youngstown, OH
  • NPI 1740398890
  NPD (past)
• Openloop Healthcare Partners PC

  • General Practice Physician
  • Des Moines, IA
  • NPI 1245820661
  NPD (past)

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

• The Surgery Center at Southwoods, LLC

  • Special Hospital
  • Youngstown, OH
  • NPI 1740398890
  Care Compare affiliation

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

{
    "created_epoch": "1319414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695772800000",
    "number": "1447536370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 645409",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152645252",
            "telephone_number": "330-386-6442",
            "fax_number": "330-386-3660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2581 NORTH RD NE",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444833052",
            "telephone_number": "234-287-6802",
            "fax_number": "330-372-4437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KIMBERLY",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-24",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "34.011422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J M Clemente Co
• J.E. Terence Kavanagh,MD,Inc.
• Alexis Adrianna Jackson
• Andrea Jackson, LPN
• Christian Joself Jackson
• Natasha Jackson
• Ramona Jackson
• Sylvia A Jackson
• Matthew Jacob, M.D.
• Jagdish H Patel MD Inc

• Family Medicine Physician in Warren, OH
• Providers in Warren, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 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.
• 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.