NPIMap

Individual provider Active NPI

Marcy Jackovic

  • Internal Medicine Physician
  • Port Charlotte, FL
National Provider Identifier
1699744888
Registry record updated Feb 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS19081 Issued in FL
Practice address
17912 Toledo Blade Blvd Unit a
Port Charlotte, FL 33948-1125
Phone
(941) 766-1001
Fax
(941) 764-7116
NPI assigned
Mar 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OS19081 FL Primary
Internal Medicine Physician 207R00000X 0S012093 PA

Addresses

Primary practice location

17912 Toledo Blade Blvd Unit a
Port Charlotte, FL 33948-1125

Mailing address

2675 Winkler Ave FL 2
Fort Myers, FL 33901-9342
Phone (877) 856-3774

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, FL2 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
I20031124000261 PA Practitioner - Internal Medicine 8022912849 Reassigns benefits to 1 organization
I20230524002212 FL Practitioner - Internal Medicine 8022912849 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Philadelphia College of Osteopathic Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Millennium Physician Group LLCGroup PAC ID 9830244433, 976 clinicians
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians

Practice addresses (Care Compare)

19531 Cochran Blvd
Port Charlotte, FL 33948-2081
Phone (941) 255-3535

7374 San Casa Dr
Englewood, FL 34224-8842
Phone (941) 417-5064

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.75 of 100Reported as group
Quality
70.53
Promoting interoperability
100
Improvement activities
40
Cost
75.31

Merit-based Incentive Payment System (MIPS)

Final score
86.02 of 100Reported as group
Quality
75.76
Promoting interoperability
100
Improvement activities
40
Cost
77.63

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
0S012093PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Upmc Community Medicine, Inc Internal Medicine Current Accepting new patients
Millennium Physician Group LLC Internal Medicine CurrentSince Jul 1, 2023 Accepting new patients
Upmc Community Medicine Inc Internal Medicine CurrentSince Jul 1, 2008 Accepting new patients
Millennium Physician Group LLC CurrentSince Jul 1, 2023 Accepting new patients
Upmc Community Medcine Inc CurrentSince Jul 1, 2008 Accepting new patients
Upmc St. Margaret Past Accepting new patients
Upmc Community Medicine Inc Internal Medicine PastSince Mar 1, 2021 Accepting new patients
Windber Hospital, Inc. Past Accepting new patients

Locations

2675 Winkler Ave
Fl 2
Fort Myers, FL 33901
Phone (855) 979-5700

17912 Toledo Blade Blvd
Unit A
Pt Charlotte, FL 33948
Phone (941) 766-1001

19531 Cochran Blvd
Pt Charlotte, FL 33948
Phone (941) 255-3535

241 Freeport Rd
Ste 3
Aspinwall, PA 15215
Phone (412) 781-8566

875 N Hermitage Rd
Ste 3
Hermitage, PA 16148
Phone (724) 347-4622

2 Hot Metal St
Fl 3
Pittsburgh, PA 15203
Phone (412) 432-5869

3937 Butler St
Pittsburgh, PA 15201
Phone (412) 621-8235

339 6th Ave
Fl 5
Pittsburgh, PA 15222
Phone (412) 560-8762

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: marcy.jackovic.1@4290.direct.athenahealth.com

Organizations & group practices 8

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770076800000",
    "number": "1699744888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "877-856-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17912 TOLEDO BLADE BLVD UNIT A",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339481125",
            "telephone_number": "941-766-1001",
            "fax_number": "941-764-7116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKOVIC",
        "first_name": "MARCY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-17",
        "last_updated": "2026-02-03",
        "certification_date": "2026-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS19081",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "0S012093",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.