NPIMap

Individual provider Active NPI

Lori Jackson, NP-C

  • Family Nurse Practitioner
  • Saint George Island, AK
National Provider Identifier
1528565710
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
130523 Issued in AK
Practice address
934 Main St
Saint George Island, AK 99591
Phone
(907) 859-2254
Fax
(907) 859-2252
NPI assigned
Apr 12, 2018
Last updated
Jun 16, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 130523 AK Primary

Addresses

Primary practice location

934 Main St
Saint George Island, AK 99591

Mailing address

17115 Monroe Dr NW
Elk River, MN 55330-4307
Phone (612) 239-3393

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20191204001141 TX Practitioner - Nurse Practitioner 7618300740 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

934 Main St
Saint George Island, AK 99591
Phone (907) 859-2254

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
130523AKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Aleutian Pribilof Islands Association Inc CurrentSince Oct 9, 2019 Accepting new patients
Aleutian Pribilof Islands Assoc Inc Current Accepting new patients
Eastern Aleutian Tribes, Inc. Past Accepting new patients

Locations

1131 E Intl Airport Rd
Anchorage, AK 99518
Phone (907) 276-2700

Interoperability endpoints

  • Direct secure messaging: lorij@direct.apiai.org

Organizations & group practices 3

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1523491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529107200000",
    "number": "1528565710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17115 MONROE DR NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553304307",
            "telephone_number": "612-239-3393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "934 MAIN ST",
            "city": "SAINT GEORGE ISLAND",
            "state": "AK",
            "postal_code": "99591",
            "telephone_number": "907-859-2254",
            "fax_number": "907-859-2252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LORI",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-12",
        "last_updated": "2018-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AK",
            "license": "130523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint George Island, AK

Sources for this page

Verify at the official NPI Registry.