Bennett J Jackson, ANP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

666 Issued in AK

Practice address

6307 Debarr Rd Ste C
Anchorage, AK 99504-1783

Phone

(907) 333-7425

Fax

(907) 333-7719

NPI assigned

Dec 13, 2006

Last updated

Nov 1, 2024By the provider in NPPES

Sex

Male

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 3

Medicare fee-for-service enrollment

Enrolled in AK

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, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Urgent Care of Soldotna IncGroup PAC ID 5698101194, 5 clinicians

Soldotna Family Practice LLCGroup PAC ID 4688039654, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bennett.jackson.1@20934.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/20934/brand/1/csg/1/fhir/r4

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.

• Urgent Care of Soldotna Inc.

  • Urgent Care Clinic/Center
  • Soldotna, AK
  • NPI 1306484332
  Medicare reassignment Care Compare group NPD
• Soldotna Family Practice LLC

  • Primary Care Clinic/Center
  • Soldotna, AK
  • NPI 1326757949
  Medicare reassignment Care Compare group
• Providence Health & Services- Washington

  dba Providence Medical Group Alaska

  • Critical Care Medicine (Internal Medicine) Physician
  • Anchorage, AK
  • NPI 1093956278
  Medicare reassignment NPD
• Providence Health & Services-Washington

  dba Providence Medical Group Alaska

  • Community/Behavioral Health Agency
  • Anchorage, AK
  • NPI 1841814795
  NPD

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730419200000",
    "number": "1568523157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110413",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995110413",
            "telephone_number": "907-333-7425",
            "fax_number": "907-333-7719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6307 DEBARR RD STE C",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995041783",
            "telephone_number": "907-333-7425",
            "fax_number": "907-333-7719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BENNETT",
        "middle_name": "J",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AK",
            "license": "666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP TAX ID",
            "identifier": "743109721",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1730113739",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP39831",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Denise Jacko, OTR/L
• Mary Stark Jacks, MSW
• Paul Charles Jacks, BA
• Maggie Annie Jackson-Fairbanks
• Amber Jackson, LMT
• Christopher Paul Jackson
• Daniel L Jackson, OTD
• Grace L Jackson
• Jayly Jermayne Jackson
• Jerline Jackson

• Nurse Practitioner in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Nurse Practitioner in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 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.