Individual provider Active NPI

Jessica Lynn Jackson, DPT

  • Physical Therapist
  • Cullman, AL
National Provider Identifier
1902146475
Registry record updated Oct 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PTH6734 Issued in AL
Practice address
1701 Main Ave SW
Cullman, AL 35055
Phone
(256) 775-3737
Fax
(256) 775-3738
NPI assigned
Feb 21, 2013
Last updated
Oct 23, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PTH6734 AL Primary

Addresses

Primary practice location

1701 Main Ave SW
Cullman, AL 35055

Mailing address

251 Johnston St SE Ste 200
Decatur, AL 35601-2515
Phone (256) 350-1764

Other practice location 1

1483 Gadsden Hwy
Suite 112
Birmingham, AL 35235-3160
Phone (205) 655-9222

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130506000528 AL Practitioner - Physical Therapist in Private Practice 8325285687 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Encore Rehabilitation, IncGroup PAC ID 3577462126, 182 clinicians

Practice addresses (Care Compare)

1510 N Brindlee Mountain Pkwy
Arab, AL 35016-5723
Phone (256) 931-2013

5643 Sermon Rd S
B
Theodore, AL 36582-3608
Phone (251) 660-1505

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PTH6734ALMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Encore Rehabilitation, Inc Physical Therapist CurrentSince Oct 4, 2019 Accepting new patients
Drayer Physical Therapy-Alabama, LLC Physical Therapist Current Accepting new patients
Drayer Physical Therapy-Alabama, LLC Physical Therapist CurrentSince Oct 1, 2013 Accepting new patients
Drayer Physical Therapy Alabama LLC CurrentSince Oct 1, 2013 Accepting new patients
Encore Rehabilitation, Inc. Physical Therapist CurrentSince Oct 4, 2019 Accepting new patients

Locations

1510 N Brindlee Mountain Pkwy
Arab, AL 35016
Phone (256) 931-2013

1483 Gadsden Hwy
Ste 112
Birmingham, AL 35235
Phone (205) 460-8000

1701 Main Ave SW
Cullman, AL 35055
Phone (256) 469-8493

251 Johnston St SE
Ste 300
Decatur, AL 35601
Phone (256) 340-9708

2215 Decatur Hwy
Ste 125
Gardendale, AL 35071
Phone (205) 285-8790

651 Main St
Ste 119
Gardendale, AL 35071
Phone (205) 608-3113

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

Organizations & group practices 5

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": "1361404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571788800000",
    "number": "1902146475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 JOHNSTON ST SE STE 200",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356012515",
            "telephone_number": "256-350-1764",
            "fax_number": "256-355-0884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 MAIN AVE SW",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "35055",
            "telephone_number": "256-775-3737",
            "fax_number": "256-775-3738"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1483 Gadsden Hwy",
            "address_2": "Suite 112",
            "address_purpose": "LOCATION",
            "city": "Birmingham",
            "state": "AL",
            "postal_code": "352353160",
            "country_code": "US",
            "telephone_number": "205-655-9222",
            "fax_number": "205-655-9233",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-21",
        "last_updated": "2019-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AL",
            "license": "PTH6734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cullman, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; 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.