Jennifer Lynn Jacks, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

E7442 Issued in AR

Practice address

1718 W 42ND Ave
Pine Bluff, AR 71603-7008

Phone

(870) 534-7546

Fax

(870) 534-2343

NPI assigned

Apr 8, 2008

Last updated

Sep 29, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

University of Arkansas College of Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jefferson Regional Medical Center Hospital, Pine Bluff, AR, CCN 040071

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jjacks@directaddress.net

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.

• Jacks Dermatology P.a.

  • Dermatology Physician
  • Pine Bluff, AR
  • NPI 1558621367
  Medicare reassignment NPD Authorized official

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

• Jefferson Hospital Association Inc

  dba Jefferson Regional Medical Center

  • General Acute Care Hospital
  • Pine Bluff, AR
  • NPI 1710931985
  Care Compare affiliation

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

{
    "created_epoch": "1207612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601337600000",
    "number": "1699948901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 W 42ND AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "71603",
            "telephone_number": "870-534-7546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1718 W 42ND AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716037008",
            "telephone_number": "870-534-7546",
            "fax_number": "870-534-2343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKS",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-08",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AR",
            "license": "E7442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roslyn R Iverson
• J. W Nuckolls MD
• Jacks Dermatology P.a.
• David Jacks, M.D.
• Dennis W Jacks, M.D.
• Angela Jackson, COTA
• Corey Lamont Jackson Sr., D.C.
• Debra A Jackson
• Denishia Nicole Jackson
• Henry Jackson

• Dermatology Physician in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Dermatology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; 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.