Individual provider Active NPI

Amy Elizabeth Jackson, PA C

  • Surgical Physician Assistant
  • Seymour, IN
National Provider Identifier
1699772954
Registry record updated Jun 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
10000733A Issued in IN
Practice address
1124 Medical PL
Seymour, IN 47274-2640
Phone
(812) 523-5185
Fax
(812) 523-3826
NPI assigned
Jul 1, 2005
Last updated
Jun 5, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 10000733A IN Primary

Addresses

Primary practice location

1124 Medical PL
Seymour, IN 47274-2640

Mailing address

1124 Medical PL
Seymour, IN 47274-2640
Phone (812) 522-1613

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20050601000893 IN Practitioner - Physician Assistant 3971545856 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1124 Medical PL
Seymour, IN 47274-2640
Phone (812) 522-1613

1130 Medical PL
Seymour, IN 47274-2640
Phone (812) 519-1552

200 S Walnut St
Schneck Medical Center
Seymour, IN 47274-2312
Phone (812) 522-2349

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.97 of 100Reported as apm
Quality
85.1
Promoting interoperability
94.69
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10000733AINMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson County Schneck Memorial Hospital CurrentSince Aug 12, 2014 Accepting new patients
Jackson County Schneck Memorial Hospital CurrentSince Aug 12, 2014 Accepting new patients
Seymour Indiana Pathologists, Inc Past Accepting new patients
Jackson County Schneck Memorial Hospital PastSince Mar 1, 2021 Accepting new patients

Locations

806 W Commerce St
Brownstown, IN 47220
Phone (812) 358-2400

1001 N Grant St
Lebanon, IN 46052
Phone (765) 482-6400

1124 Medical Pl
Seymour, IN 47274
Phone (812) 519-1552

1130 Medical Pl
Seymour, IN 47274
Phone (812) 519-1552

200 S Walnut St
Seymour, IN 47274
Phone (812) 522-2349

411 W Tipton St
Seymour, IN 47274
Phone (317) 888-3505

411 W Tipton St
Fl 4
Seymour, IN 47274
Phone (812) 523-5862

411 W Tipton St
Ste 4
Seymour, IN 47274

Organizations & group practices 4

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 1

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": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780617600000",
    "number": "1699772954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 MEDICAL PL",
            "city": "SEYMOUR",
            "state": "IN",
            "postal_code": "472742640",
            "telephone_number": "812-522-1613",
            "fax_number": "812-522-6694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 MEDICAL PL",
            "city": "SEYMOUR",
            "state": "IN",
            "postal_code": "472742640",
            "telephone_number": "812-523-5185",
            "fax_number": "812-523-3826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AMY",
        "middle_name": "ELIZABETH",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-01",
        "last_updated": "2026-06-05",
        "certification_date": "2026-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IN",
            "license": "10000733A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seymour, IN

Sources for this page

Verify at the official NPI Registry.