Amanda J Jackson, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71009089A Issued in IN

Practice address

2811 Holmans LN
Jeffersonville, IN 47130-5915

Phone

(502) 446-5555

Fax

(502) 394-3674

NPI assigned

Apr 10, 2019

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 identifiers 2

Other names 1

• Amanda Wade Former name

Medicare fee-for-service enrollment

Enrolled in KY, IN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Medical Associates IncGroup PAC ID 7012811284, shared by 2 NPIs, 1,368 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

81.11 of 100Reported as group

Quality

63.34

Promoting interoperability

100

Improvement activities

40

Cost

73.68

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8360/brand/1/csg/1/fhir/r4
• Direct secure messaging: awade203432@direct.nortonhealthcare.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.

• Louisville Geriatric Associates

  • Geriatric Medicine (Internal Medicine) Physician
  • Jeffersonville, IN
  • NPI 1871508614

  Family, KY

  Medicare reassignment NPD
• Louisville Geriatric Associates

  • Internal Medicine Physician
  • Jeffersonville, IN
  • NPI 1922337617

  Family

  Medicare reassignment NPD
• Community Medical Associates, Inc.

  • Multi-Specialty Clinic/Center
  • Louisville, KY
  • NPI 1306983762

  Family

  Medicare reassignment NPD
• Community Medical Associates, Inc.

  • Internal Medicine Physician
  • Louisville, KY
  • NPI 1588614994

  IN

  Medicare reassignment NPD
• Community Medical Associates, Inc.

  • Multi-Specialty Clinic/Center
  • Louisville, KY
  • NPI 1073089850

  Family

  NPD
• Community Medical Associates, Inc.

  • Internal Medicine Physician
  • Louisville, KY
  • NPI 1881192409
  NPD
• Community Medical Associates, Inc.

  • Neurological Surgery Physician
  • Louisville, KY
  • NPI 1922288760
  NPD (past)

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

{
    "created_epoch": "1554854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1922561653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776351",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776351",
            "telephone_number": "025-889-4905",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2811 HOLMANS LN",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471305915",
            "telephone_number": "502-446-5555",
            "fax_number": "502-394-3674"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "443 Spring St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Jeffersonville",
            "state": "IN",
            "postal_code": "471304494",
            "country_code": "US",
            "telephone_number": "812-288-8360",
            "fax_number": "812-288-8375",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "443 Spring St Ste 301",
            "address_purpose": "LOCATION",
            "city": "Jeffersonville",
            "state": "IN",
            "postal_code": "471304494",
            "country_code": "US",
            "telephone_number": "812-288-8360",
            "fax_number": "812-288-8375",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "AMANDA",
        "middle_name": "J",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-10",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71009089A",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3013285",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100604600",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300027709",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "WADE",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Olegario J Ignacio Jr., MD
• Indiana Center for Recovery Outpatient Services LLC
• Infectious Diseases Specialists of Kentuckiana LLC
• Lakhwinder Insan, APRN
• Constance Lee Isaacs, RBT
• Brianna Jackson, RBT
• Jada Jackson, RBT
• Noah Jackson, RBT
• Joseph W. Jacobi, DDS
• Stacey L Jacobs, NP

• Family Nurse Practitioner in Jeffersonville, IN
• Providers in Jeffersonville, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; 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.