Ronica Jackson, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

28208894A Issued in IN

Practice address

3512 Stellhorn Rd
Fort Wayne, IN 46815-4631

Phone

(260) 483-9081

NPI assigned

Jul 23, 2024

Sex

Female

Sole proprietor

No

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 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

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Eventus Ecs, IncGroup PAC ID 2163969650, 243 clinicians

Extended Care Specialists, IncGroup PAC ID 2466407713, 295 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Eventus Ecs, Inc

  • Nurse Practitioner
  • Indianapolis, IN
  • NPI 1073353496
  Medicare reassignment Care Compare group NPD
• Extended Care Specialists, Inc

  • Adult Medicine Physician
  • Merrillville, IN
  • NPI 1134146079
  Medicare reassignment Care Compare group NPD
• Eventus Wholehealth Midwest Inc

  • Family Medicine Physician
  • Columbus, IN
  • NPI 1386252757
  Medicare reassignment NPD
• Eventus Ecs - Kentucky, PLLC

  • Nurse Practitioner
  • Lexington, KY
  • NPI 1396563276

  IN

  Medicare reassignment NPD
• Eventus WH Midwest Care, LLC

  • Nurse Practitioner
  • Concord, NC
  • NPI 1588481717

  IN

  Medicare reassignment NPD

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

{
    "created_epoch": "1721692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1780412783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 392552",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152519500",
            "telephone_number": "512-792-4402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3512 STELLHORN RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468154631",
            "telephone_number": "260-483-9081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "RONICA",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-23",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "28208894A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lori Elizabeth Jackson, CRNA
• Luke Jackson
• Monique Jackson, PHARMD
• Richard T Jackson, D.P.M.
• Robert Franklin Jackson II, D.O.
• Sheryl D Jackson, MS
• Summer Jackson
• Tosha N Jackson, LPN
• Tywanna Lashea Jackson, COTA
• Walter Osborne Jackson, MD

• Psychiatric/Mental Health Nurse Practitioner in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; 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.