Dr Nicole Etta Jackson, DO - Medicare Family Practice in Dallas, TX

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Dr Nicole Etta Jackson, DO is a medicare enrolled "Family Medicine" physician in Dallas, Texas. She graduated from medical school in 2017 and has 9 years of diverse experience with area of expertise as Family Practice. She is a member of the group practice Legacy Healthcare Services Inc, Fhpg Llc and her current practice location is 325 N Saint Paul St Ste 3100, Dallas, Texas. You can reach out to her office (for appointments etc.) via phone at (617) 505-1520.

Dr Nicole Etta Jackson is licensed to practice in Texas (license number W7943) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1578084927.

Contact Information

Dr Nicole Etta Jackson, DO
325 N Saint Paul St Ste 3100,
Dallas, TX 75201-3923
(617) 505-1520
(617) 928-8401

Map and Direction




Physician's Profile

Full NameDr Nicole Etta Jackson
GenderFemale
SpecialityFamily Practice
Experience9 Years
Location325 N Saint Paul St Ste 3100, Dallas, Texas
Accepts Medicare AssignmentsYes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Dr Nicole Etta Jackson graduated from medical school in 2017
  NPI Data:
  • NPI Number: 1578084927
  • Provider Enumeration Date: 07/06/2017
  • Last Update Date: 09/25/2026
  Medicare PECOS Information:
  • PECOS PAC ID: 6800162603
  • Enrollment ID: I20201008000670

Medical Identifiers

Medical identifiers for Dr Nicole Etta Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1578084927NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207Q00000XFamily Medicine 2020-04019 (North Carolina)Secondary
207Q00000XFamily Medicine 009754 (Georgia)Secondary
207Q00000XFamily Medicine W7943 (Texas)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Liberty Home CareSouthern pines, NCHome health agency
Firsthealth Moore Regional HospitalPinehurst, NCHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Legacy Healthcare Services Inc21633397223431
Fhpg Llc9537481569195

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. Dr Nicole Etta Jackson allows following entities to bill medicare on her behalf.
Entity NameFirsthealth of the Carolinas Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1548276389
PECOS PAC ID: 8820909377
Enrollment ID: O20031108000016
Entity NameMcpc-2 LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1962737452
PECOS PAC ID: 1254473630
Enrollment ID: O20100122000627
Entity NameMcpc-7 LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1881968709
PECOS PAC ID: 9739341066
Enrollment ID: O20120503000387
Entity NameMcpc-8 LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1922552322
PECOS PAC ID: 3870740012
Enrollment ID: O20120823000423
Entity NameMcpc-16 LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1114351095
PECOS PAC ID: 4082841465
Enrollment ID: O20131210000462
Entity NameFhpg LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1760329486
PECOS PAC ID: 9537481569
Enrollment ID: O20141202002644
Entity NameMcpc-17 LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1518312073
PECOS PAC ID: 5395030159
Enrollment ID: O20160818002018

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. Dr Nicole Etta 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 AddressPractice Location Address
Dr Nicole Etta Jackson, DO
109 State St Ste 5,
Boston, MA 02109-2906

Ph: (617) 505-1520		Dr Nicole Etta Jackson, DO
325 N Saint Paul St Ste 3100,
Dallas, TX 75201-3923

Ph: (617) 505-1520

Reviews and Comments


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Mary Elizabeth Wilcox Smith, M.D.
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Elizabeth Chapek, DO
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Mehreen Amjad Malik, MD
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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.