Katrina Marcia Jackson, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

576 Issued in CT

Practice address

3 Shaws CV Ste 206
New London, CT 06320-4968

Phone

(860) 443-4148

NPI assigned

Jul 29, 2024

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 CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Certified Nurse Midwife (CNM)

Education

Yale University School of Medicine, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeast Medical Group IncGroup PAC ID 1254233836, 1,357 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kjackson604094@direct.ynhh.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.

• Northeast Medical Group, Inc.

  • Internal Medicine Physician
  • Bridgeport, CT
  • NPI 1043278351
  Medicare reassignment Care Compare group NPD
• Mill Hill Medical Consultants Inc

  • Cardiovascular Disease Physician
  • Greenwich, CT
  • NPI 1396755245
  NPD

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

{
    "created_epoch": "1722211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1548099757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 CENTER ST",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065164204",
            "telephone_number": "405-464-8126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 SHAWS CV STE 206",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204968",
            "telephone_number": "860-443-4148"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "365 Montauk Ave",
            "address_purpose": "LOCATION",
            "city": "New London",
            "state": "CT",
            "postal_code": "063204769",
            "country_code": "US",
            "telephone_number": "860-441-0711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KATRINA",
        "middle_name": "MARCIA",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-29",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "CT",
            "license": "576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICUT STATE NURSE MIDWIFE LICENSE",
            "identifier": "576",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ingrid M. H. Feder MD LLC
• Bizu Irving, D.D.S.
• Chris Islieb
• Kayla Izbicki, MA
• Steven M Jack, LCSW
• Nadia Jackson
• Tonya R Jackson, MS, LPC-A
• Hannah Jacob, APRN
• Silvia R Jacobowitz, PTA
• Carmen Renee Jacobson, LMSW

• Advanced Practice Midwife in New London, CT
• Providers in New London, CT by specialty
• Advanced Practice Midwife in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 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.