NPIMap

Individual provider Active NPI

Jonathan Mark Tackett, D.O.

  • Family Medicine Physician
  • Prestonsburg, KY
National Provider Identifier
1922369974
Registry record updated Feb 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
03794 Issued in KY
Practice address
1279 Old Abbott Mountain Rd
Prestonsburg, KY 41653-1889
Phone
(606) 886-1260
Fax
(606) 886-3590
NPI assigned
Jun 6, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 03794 KY Primary

Addresses

Primary practice location

1279 Old Abbott Mountain Rd
Prestonsburg, KY 41653-1889

Mailing address

PO Box 1595
Ashland, KY 41105-1595
Phone (606) 408-6200

Other identifiers 2

IdentifierTypeStateIssuer
0160277MedicaidOH
7100406690MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20160331001044 KY Practitioner - Family Practice 5092012351 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ashland Hospital CorporationGroup PAC ID 7719882521, 169 clinicians

Practice addresses (Care Compare)

609 N Carol Malone Blvd
Grayson, KY 41143-1123
Phone (606) 474-7892

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.16 of 100Reported as group
Quality
77.42
Promoting interoperability
100
Improvement activities
40
Cost
77.62

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
03794KYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ashland Hospital Corporation Family Medicine CurrentSince Jun 1, 2018 Accepting new patients
Ashland Hospital Corporation Family Medicine CurrentSince Jun 1, 2018 Accepting new patients
Ashland Hospital Corporation Current Accepting new patients
Ashland Hospital Corporation Family Medicine Past Accepting new patients

Locations

10650 US Route 60
Ashland, KY 41102
Phone (606) 408-6301

2201 Lexington Ave
Ashland, KY 41101
Phone (606) 268-2560

12100 Princeland Spur
Ashland, KY 41102
Phone (606) 928-2963

4004 Louisa Rd
Catlettsburg, KY 41129
Phone (606) 739-6095

609 N Carol Malone Blvd
Grayson, KY 41143
Phone (606) 324-1070

Interoperability endpoints

  • Direct secure messaging: jtackett55716@direct.kdhealth.us

Organizations & group practices 4

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.

Hospital & facility affiliations 6

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": "1338940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486425600000",
    "number": "1922369974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1595",
            "city": "ASHLAND",
            "state": "KY",
            "postal_code": "411051595",
            "telephone_number": "606-408-6200",
            "fax_number": "606-408-6612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1279 OLD ABBOTT MOUNTAIN RD",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416531889",
            "telephone_number": "606-886-1260",
            "fax_number": "606-886-3590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKETT",
        "first_name": "JONATHAN",
        "middle_name": "MARK",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-06",
        "last_updated": "2017-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "03794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0160277",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100406690",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prestonsburg, KY

Sources for this page

Verify at the official NPI Registry.