Individual provider Active NPI

Kristina M Jackson, AUD.

  • Audiologist
  • Amherst, NY
National Provider Identifier
1821061474
Registry record updated Sep 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
001607-0 Issued in NY
Practice address
4600 Main St
Suite 201
Amherst, NY 14226-4500
Phone
(716) 833-4488
Fax
(716) 839-1218
NPI assigned
Feb 13, 2006
Last updated
Sep 21, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 001607-0 NY Primary

Addresses

Primary practice location

4600 Main St
Suite 201
Amherst, NY 14226-4500

Mailing address

4600 Main St
Suite 201
Amherst, NY 14226-4500
Phone (716) 833-4488

Other identifiers 6

IdentifierTypeStateIssuer
000580000005OtherNYBC/BS-HEARING AID-OP
000576103001OtherNYBC/BS-AUDIOLOGIST-H
9200301OtherNYIHA
000576103003OtherNYBC/BS-AUDIOLOGIST-OP
000580000003OtherNYBC/BS-HEARING AID-H
00011176701OtherNYUNIVERA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080702000273 NY Practitioner - Qualified Audiologist 6608948930 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hearing Evaluation Services of Buffalo IncGroup PAC ID 8325096928, 19 clinicians

Practice addresses (Care Compare)

4600 Main St
Suite 201
Amherst, NY 14226-4500
Phone (716) 833-4488

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
001607-0NYMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Hearing Evaluation Services of Buffalo, Inc. Audiologist CurrentSince Oct 1, 2000 Accepting new patients
Life Sounds Audiology, Inc CurrentSince Mar 29, 2020 Accepting new patients

Locations

4063 N Buffalo St
Ste 3
Orchard Park, NY 14127
Phone 7168334488 ext. 503

4600 Main St
Ste 201
Snyder, NY 14226
Phone (716) 650-5088

2545 Sheridan Dr
Ste 5
Tonawanda, NY 14150
Phone 7168334488 ext. 503

2733 Wehrle Dr
Ste 200
Williamsville, NY 14221
Phone 7168334488 ext. 503

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285027200000",
    "number": "1821061474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 MAIN ST",
            "address_2": "SUITE 201",
            "city": "AMHERST",
            "state": "NY",
            "postal_code": "142264500",
            "telephone_number": "716-833-4488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 MAIN ST",
            "address_2": "SUITE 201",
            "city": "AMHERST",
            "state": "NY",
            "postal_code": "142264500",
            "telephone_number": "716-833-4488",
            "fax_number": "716-839-1218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KRISTINA",
        "middle_name": "M",
        "credential": "AUD.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-13",
        "last_updated": "2010-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NY",
            "license": "001607-0",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS-HEARING AID-OP",
            "identifier": "000580000005",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS-AUDIOLOGIST-H",
            "identifier": "000576103001",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHA",
            "identifier": "9200301",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS-AUDIOLOGIST-OP",
            "identifier": "000576103003",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS-HEARING AID-H",
            "identifier": "000580000003",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00011176701",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Amherst, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.