Nicole Kimberly Jackson, DO

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

OP60418108 Issued in WA

Practice address

525 Lilly Rd NE Ste 200
Olympia, WA 98506

Phone

(360) 493-4510

Fax

(360) 493-7759

NPI assigned

Feb 21, 2010

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

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

Thoracic SurgeryAlso: General Surgery

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PeacehealthGroup PAC ID 9537073960, 292 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peacehealth St Joseph Medical Center Hospital, Bellingham, WA, CCN 500030
• Island Hospital Hospital, Anacortes, WA, CCN 500007

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: njackson455931@direct.peacehealth.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.

• Peacehealth

  • Internal Medicine Physician
  • Bellingham, WA
  • NPI 1356309553

  Thoracic Surgery (Cardiothoracic Vascular Surgery)

  Medicare reassignment Care Compare group NPD
• Providence Health & Services Washington

  • Family Medicine Physician
  • Olympia, WA
  • NPI 1174744304
  Medicare reassignment NPD
• Providence Health & Services Washington

  • General Practice Physician
  • Olympia, WA
  • NPI 1134656135
  NPD
• Peacehealth

  • Sleep Disorder Diagnostic Clinic/Center
  • Bellingham, WA
  • NPI 1265692842
  NPD (past)
• Peacehealth

  • Rural Acute Care Hospital
  • Bellingham, WA
  • NPI 1487904546
  NPD (past)

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

• Peacehealth

  • Rural Acute Care Hospital
  • Bellingham, WA
  • NPI 1487904546
  Care Compare affiliation
• Peacehealth

  • General Acute Care Hospital
  • Bellingham, WA
  • NPI 1689677320
  Care Compare affiliation
• Public Hospital District No 2 Skagit County Washington

  • General Acute Care Hospital
  • Anacortes, WA
  • NPI 1710913140
  Care Compare affiliation
• St Joseph Hospital

  • Clinical Medical Laboratory
  • Bellingham, WA
  • NPI 1013137173

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1266710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528761600000",
    "number": "1508188343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 LILLY RD NE STE 200",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "98506",
            "telephone_number": "360-493-4510",
            "fax_number": "360-493-7759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NICOLE",
        "middle_name": "KIMBERLY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-21",
        "last_updated": "2018-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "WA",
            "license": "OP60418108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OL60099734",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chris Noel Iverson, LMP
• Adaugo Onyekachi Iwuchukwu
• J. Hyung Choi, DDS, P.C.
• Carla Jacks
• Brian James Jackson, DDS
• Tannalia Virginia Jackson
• Shalini Mary Jacob, M.D., MRCP, FACP
• William Chase Jacob, PHARMD
• Jayme Jean Jacobs
• Linda D Jacobsen, ARNP

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Olympia, WA
• Providers in Olympia, WA by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2018; 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.