Emily Sarah Jackson, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1073112 Issued in TX

Practice address

501 Congress Ave Ste 450
Austin, TX 78701-3556

Phone

(866) 932-5104

NPI assigned

Jul 21, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NH, LA, DE, KY, PA, MD, AL, GA, VA, AZ, AR11 enrollments

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 11

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cupid Medical PSCGroup PAC ID 3072913961, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: emily.jackson@552337174953988.direct.elationemr.com

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.

• Cupid Medical PSC

  • Cardiovascular Disease Physician
  • Dover, DE
  • NPI 1538753876

  AL, AR, AZ, GA, KY, LA, MD, NH, PA, VA

  Medicare reassignment Care Compare group
• Cupid Medical of California P.C.

  • Internal Medicine Physician
  • San Jose, CA
  • NPI 1447967922
  NPD (past)

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

{
    "created_epoch": "1658361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1609501741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 THE GRN STE 1670",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199013618",
            "telephone_number": "866-932-5104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 CONGRESS AVE STE 450",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787013556",
            "telephone_number": "866-932-5104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "EMILY",
        "middle_name": "SARAH",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-21",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1073112",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1073112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "emily@eczemaspecialist.com",
            "affiliation": "Y",
            "endpointDescription": "work email address",
            "affiliationName": "Dr. John Van Wagoner Eczema Specialist",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1617 White Way Dr",
            "city": "Arlington",
            "state": "TX",
            "country_code": "US",
            "postal_code": "760131782",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Courtney Marie Jackson, M.S., CCC-SLP
• Dominic A Jackson, DPT
• Donnita Kaye Jackson
• Elizabeth Jean Jackson, ACNS BC
• Elizabeth Plumer Jackson, DO
• Erica L Jackson, CRNA
• Grace Nightingale Cortez Jackson, M.D.
• Gregory Allen Jackson, DPT
• Ivan Jesse Jackson, CRNA
• Jacqueline D. Jackson

• Family Nurse Practitioner in Austin, TX
• Providers in Austin, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.