Carrie Rose Klotz Jackson, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

256859 Issued in NY

Practice address

134 Homer Ave
Cortland, NY 13045-1206

Phone

(410) 409-5844

NPI assigned

Jun 11, 2007

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 names 1

• Carrie Rose Klotz Former name

Medicare fee-for-service enrollment

Enrolled in NY

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

Emergency Medicine

Education

Johns Hopkins University School of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Medicine Physicians of Cortland County PLLCGroup PAC ID 6002802725, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Guthrie Cortland Regional Medical Center Hospital, Cortland, NY, CCN 330175

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cjackson162408@direct-guthrie.org

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.

• Emergency Medicine Physicians of Cortland County, PLLC

  • Emergency Medicine Physician
  • Cortland, NY
  • NPI 1609816024
  Medicare reassignment Care Compare group NPD

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

• Guthrie Cortland Medical Center

  • General Acute Care Hospital
  • Cortland, NY
  • NPI 1740287531
  Care Compare affiliation

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319500800000",
    "number": "1851595334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 HOMER AVE",
            "city": "CORTLAND",
            "state": "NY",
            "postal_code": "130451206",
            "telephone_number": "410-409-5844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 HOMER AVE",
            "city": "CORTLAND",
            "state": "NY",
            "postal_code": "130451206",
            "telephone_number": "410-409-5844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CARRIE",
        "middle_name": "ROSE KLOTZ",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-11",
        "last_updated": "2011-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "256859",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "MD0000045187",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARRIE",
            "last_name": "KLOTZ",
            "middle_name": "ROSE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Garrett Imbrenda, LMSW
• William G Innerst, RPH
• Michael Richard Izzo, PHARMD
• J. M. Murray Center, Inc.
• Jack T. Sproul, MD PC (Cortland Orthopedics)
• Joseph Jacobi
• Jacobus Center for Reproductive Health
• Kim Moon Ja Jacoby, RN, BS
• James S Leonard, DPM PC
• Matthew James, PHARMD

• Emergency Medicine Physician in Cortland, NY
• Providers in Cortland, NY by specialty
• Emergency Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2011; 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.