Kristen A Jackson, PT,DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070-017006 Issued in IL

Practice address

6255 S Archer Ave
Chicago, IL 60638-2609

Phone

(773) 284-6735

Fax

(773) 284-6820

NPI assigned

Sep 28, 2006

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

• Kristen A Bell Former name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Impulse Rehab and Wellness PLLCGroup PAC ID 4688905995, 7 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.

• Impulse Rehab and Wellness, PLLC

  • Physical Therapist
  • Westchester, IL
  • NPI 1215598941
  Medicare reassignment Care Compare group NPD
• South St. Louis Rehabilitation Institute, Inc.

  • Physical Therapist
  • Saint Louis, MO
  • NPI 1568484681
  NPD (past)

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317340800000",
    "number": "1912098252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6255 S ARCHER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606382609",
            "telephone_number": "773-284-6735",
            "fax_number": "773-284-6820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6255 S ARCHER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606382609",
            "telephone_number": "773-284-6735",
            "fax_number": "773-284-6820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KRISTEN",
        "middle_name": "A",
        "credential": "PT,DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2011-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MO",
            "license": "220961806",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-017006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "BELL",
            "middle_name": "A",
            "credential": "PT,DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kendel Jackson
• Kenneth Jackson, PH.D.
• Ketajia Jackson, LPC
• Kiqiana Jackson
• Kristan Jackson, MS OTR/L
• Kristina Jackson, PT, DPT, MS
• Kurt H Jackson
• Lanore Jackson
• Lashawnna Chanel Jackson
• Latiara Jackson, MA COUNSELING

• Physical Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2011; 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.