NPIMap

Individual provider Active NPI

Jason Keith Fackler, ARNP

  • Acute Care Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1609564566
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
3019095 Issued in KY
Practice address
201 Abraham Flexner Way Ste 1105
Louisville, KY 40202-3841
Phone
(502) 367-4500
NPI assigned
Apr 28, 2023
Last updated
Sep 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 3019095 KY Primary
Cardiovascular Disease Physician 207RC0000X APRN11026036 FL

Addresses

Primary practice location

201 Abraham Flexner Way Ste 1105
Louisville, KY 40202-3841

Mailing address

PO Box 909
Louisville, KY 40201-0909
Phone (502) 367-4500

Other practice location 1

803 E Dixie Ave Fl 34748
Leesburg, FL 34748-6013
Phone (352) 530-2256

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, KY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230612002454 FL Practitioner - Nurse Practitioner 1850296310 Reassigns benefits to 1 organization
I20241030004422 KY Practitioner - Nurse Practitioner 1850296310 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Baptist Health Medical Group IncGroup PAC ID 5597867184, 2,431 clinicians

Practice addresses (Care Compare)

200 Cardinal Dr
Suite 308
Elizabethtown, KY 42701-2787
Phone (270) 765-5921

201 Abraham Flexner Way
Suite 1101
Louisville, KY 40202-3841
Phone (502) 581-1951

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.96 of 100Reported as group
Quality
56.12
Promoting interoperability
100
Improvement activities
40
Cost
73.73

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN11026036FLMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health Medical Group Inc CurrentSince Dec 1, 2025 Accepting new patients
University of Louisville Physicians, Inc. CurrentSince Sep 1, 2024 Accepting new patients
University of Louisville Physicians, Inc. Current Accepting new patients
University of Louisville Phyisicians, Inc. CurrentSince Sep 1, 2024 Accepting new patients
Cardiothoracic & Vascular Surgical Associates PA Cardiovascular Disease CurrentSince May 22, 2023 Accepting new patients
Baptist Health Medical Group Inc Cardiovascular Disease Current Accepting new patients
Baptist Health Medical Group Inc CurrentSince Dec 1, 2025 Accepting new patients
University of Louisville Physicians Inc. Past Accepting new patients
Baptist Health Medical Group Inc Past Accepting new patients
Dale Roberts MD, DMD PastSince Sep 23, 2024 Accepting new patients

Locations

1032 Mar Walt Dr
Unit 250
Ft Walton Bch, FL 32547
Phone (850) 682-0032

1824 King St
Ste 200
Jacksonville, FL 32204
Phone (904) 384-3343

803 E Dixie Ave
Leesburg, FL 34748
Phone (352) 530-2256

7752 Solution Ctr
Chicago, IL 60677

200 Cardinal Dr
Ste 308
Elizabethtown, KY 42701

201 Abraham Flexner Way
Ste 1101
Louisville, KY 40202
Phone (502) 568-1455

571 S Floyd St
Louisville, KY 40202
Phone (502) 561-2700

2603 Kentucky Ave
Ste 304
Paducah, KY 42003
Phone (270) 415-4800

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: jfackler45115@uoflhealth-dm.org

Organizations & group practices 10

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 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1682640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1609564566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 909",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402010909",
            "telephone_number": "502-367-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 ABRAHAM FLEXNER WAY STE 1105",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402023841",
            "telephone_number": "502-367-4500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "803 E Dixie Ave Fl 34748",
            "address_purpose": "LOCATION",
            "city": "Leesburg",
            "state": "FL",
            "postal_code": "347486013",
            "country_code": "US",
            "telephone_number": "352-530-2256",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FACKLER",
        "first_name": "JASON",
        "middle_name": "KEITH",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-28",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "KY",
            "license": "3019095",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "APRN11026036",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.