Michelle Jackson, FNP-BC is a medicare enrolled "Nurse Practitioner" in Mastic, New York. Her current practice location is
163 Poospatuck Ln, Mastic, New York. You can reach out to her office (for appointments etc.) via phone at
(631) 772-4622.
Michelle Jackson is licensed to practice in New York (license number 344797) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1306095658.
Provider's Profile
Full Name | Michelle Jackson |
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Gender | Female |
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Speciality | Nurse Practitioner |
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Location | 163 Poospatuck Ln, Mastic, New York |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1306095658
- Provider Enumeration Date: 09/11/2008
- Last Update Date: 04/16/2020
Medicare PECOS Information:
- PECOS PAC ID: 8325475015
- Enrollment ID: I20200218002289
Medical Identifiers
Medical identifiers for Michelle Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1306095658 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
363L00000X | Nurse Practitioner | 344797 (New York) | Primary |
163W00000X | Registered Nurse | 503813 (New York) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Michelle Jackson allows following entities to bill medicare on her behalf.
Entity Name | Sun River Health Inc. |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1568526838 PECOS PAC ID: 6608783568 Enrollment ID: O20040714000375 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Michelle Jackson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Michelle Jackson, FNP-BC 163 Poospatuck Ln, Mastic, NY 11950-5201 Ph: (631) 772-4622 | Michelle Jackson, FNP-BC 163 Poospatuck Ln, Mastic, NY 11950-5201 Ph: (631) 772-4622 |
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