Nicole M. Jackson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

66831 Issued in CT

Practice address

130 Hartford Rd
Manchester, CT 06040-5921

Phone

(860) 533-4673

NPI assigned

May 4, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

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

Family Practice

Education

Harvard Medical School, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prospect CT Medical Foundation IncGroup PAC ID 7416244496, 287 clinicians

Hartford Healthcare Medical Group IncGroup PAC ID 1153573902, 257 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hartford Healthcare at Home Home health agency, East Hartford, CT, CCN 077041
• Manchester Memorial Hospital Hospital, Manchester, CT, CCN 070027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nicolejackson@mpp.allscriptsdirect.net

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.

• Prospect CT Medical Foundation, Inc.

  • Family Medicine Physician
  • Manchester, CT
  • NPI 1144677568
  Medicare reassignment Care Compare group NPD
• Hartford Healthcare Medical Group, Inc

  • Surgery Physician
  • Wethersfield, CT
  • NPI 1043561301
  Medicare reassignment Care Compare group
• Medical Access P.C.

  • Urgent Care Clinic/Center
  • Germantown, MD
  • NPI 1144291204
  NPD

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

• Hartford Healthcare at Home, Inc

  • Home Health Agency
  • Wethersfield, CT
  • NPI 1073529566
  Care Compare affiliation
• Manchester Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Manchester, CT
  • NPI 1881564664
  Care Compare affiliation

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

{
    "created_epoch": "1430697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778630400000",
    "number": "1710364211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 ALBANY ST FL G",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021193791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 HARTFORD RD",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060405921",
            "telephone_number": "860-533-4673"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Boston Medical Ctr Pl",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021182908",
            "country_code": "US",
            "telephone_number": "617-414-4465",
            "fax_number": "617-414-3345",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "637 Washington St",
            "address_purpose": "LOCATION",
            "city": "Dorchester",
            "state": "MA",
            "postal_code": "02124",
            "country_code": "US",
            "telephone_number": "617-825-9660",
            "fax_number": "617-822-8222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NICOLE",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-04",
        "last_updated": "2026-05-13",
        "certification_date": "2026-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "66831",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "274945",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110108346A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aline Iskandar, M.D.
• Quazi T Islam, MD
• Its My Life Counseling and Wellness Services PLLC
• Richard Lee Jablow, MD
• Margaret Jackson
• Reginald Jackson
• Shannon Jackson, PSY.D.
• John Jacob
• Wells C Jacobson, MD
• Jennifer Michelle Jahn

• Family Medicine Physician in Manchester, CT
• Providers in Manchester, CT by specialty
• Family Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2026; 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.