NPIMap

Individual provider Active NPI

Tiffany A Jackson, CNM

  • Advanced Practice Midwife
  • York, PA
National Provider Identifier
1922299452
Registry record updated Apr 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
MW010667 Issued in PA
Practice address
1693 S Queen St
York, PA 17403-4609
Phone
(717) 845-1621
Fax
(717) 854-6939
NPI assigned
Aug 8, 2007
Last updated
Apr 6, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 6, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X AP2784 AZ
Advanced Practice Midwife 367A00000X MW010667 PA Primary

Addresses

Primary practice location

1693 S Queen St
York, PA 17403-4609

Mailing address

3421 Concord Rd
York, PA 17402-9001
Phone (717) 845-1621

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220207002144 PA Practitioner - Certified Nurse Midwife (CNM) 7517197288 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Nurse Midwife (CNM)
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

400 Highland Ave
Lewistown, PA 17044-1167
Phone (717) 248-5411

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
MW010667PAMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspan Medical Group CurrentSince Feb 1, 2022 Accepting new patients
Geisinger Clinic Current Accepting new patients
Wellspan Medical Group CurrentSince Feb 1, 2022 Accepting new patients
Geisinger Clinic CurrentSince Jun 17, 2024 Accepting new patients
Wellspan Medical Group Current Accepting new patients
Geisinger Clinic CurrentSince Jun 17, 2024 Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

400 Highland Ave
Lewistown, PA 17044
Phone (717) 242-7473

1693 S Queen St
York, PA 17403
Phone (717) 356-5330

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

3421 Concord Rd
York, PA 17402
Phone (717) 851-2441

Interoperability endpoints

  • Direct secure messaging: tjackson292411@wellspan.direct-ci.com

Organizations & group practices 6

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1186531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649203200000",
    "number": "1922299452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 CONCORD RD",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174029001",
            "telephone_number": "717-845-1621",
            "fax_number": "717-854-6939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1693 S QUEEN ST",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174034609",
            "telephone_number": "717-845-1621",
            "fax_number": "717-854-6939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TIFFANY",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "CNM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-08",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "AZ",
            "license": "AP2784",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "PA",
            "license": "MW010667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in York, PA

Sources for this page

Verify at the official NPI Registry.