Individual provider Active NPI

Teri Lynn Jackson, ARNP

  • Pediatric Nurse Practitioner
  • Orlando, FL
National Provider Identifier
1659486652
Registry record updated Nov 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
ARNP3131802 Issued in FL
Practice address
60 W Gore St
Orlando, FL 32806-1141
Phone
(321) 841-3338
Fax
(321) 841-2170
NPI assigned
Aug 20, 2006
Last updated
Nov 14, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X ARNP3131802 FL Primary

Addresses

Primary practice location

60 W Gore St
Orlando, FL 32806-1141

Mailing address

60 W Gore St
Orlando, FL 32806-1141
Phone (321) 841-3338

Other identifiers 2

IdentifierTypeStateIssuer
ARNP3131802OtherFLMEDICAL LICENSE
001951500MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20090714000288 FL Practitioner - Nurse Practitioner 3678625134 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

60 W Gore St
Orlando, FL 32806-1141
Phone (407) 423-1039

Merit-based Incentive Payment System (MIPS)

Final score
79.91 of 100Reported as group
Quality
61.18
Promoting interoperability
100
Improvement activities
40
Cost
71.86

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health, Inc. Current Accepting new patients
Orlando Health Medical Group Inc CurrentSince Aug 12, 2018 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Aug 12, 2018 Accepting new patients
Orlando Health Inc Past Accepting new patients
Orlando Health Inc Past Accepting new patients
Orlando Health Inc Past Accepting new patients

Locations

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

60 W Gore St
Orlando, FL 32806
Phone (321) 841-3338

733 S Goldenrod Rd
Orlando, FL 32822
Phone (407) 664-0515

89 W Copeland Dr
Fl 3
Orlando, FL 32806
Phone (321) 841-3040

Interoperability endpoints

  • Direct secure messaging: tjackson33294@orlandohealth.medalliesdirect.net

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479081600000",
    "number": "1659486652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 W GORE ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061141",
            "telephone_number": "321-841-3338",
            "fax_number": "321-841-2170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 W GORE ST",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061141",
            "telephone_number": "321-841-3338",
            "fax_number": "321-841-2170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TERI",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-20",
        "last_updated": "2016-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "ARNP3131802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ARNP3131802",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001951500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.