Dr Lastasha R Jackson, CRNP is a medicare enrolled "Nurse Practitioner - Family" in Woodlyn, Pennsylvania. Her current practice location is
215 Bullens Ln, Woodlyn, Pennsylvania. You can reach out to her office (for appointments etc.) via phone at
(484) 416-0769.
Dr Lastasha R Jackson is licensed to practice in Pennsylvania (license number SP022131) 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 1356911325.
Provider's Profile
Full Name | Dr Lastasha R Jackson |
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Gender | Female |
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Speciality | Nurse Practitioner - Family |
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Location | 215 Bullens Ln, Woodlyn, Pennsylvania |
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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: 1356911325
- Provider Enumeration Date: 06/30/2021
- Last Update Date: 06/30/2021
Medicare PECOS Information:
- PECOS PAC ID: 9931585577
- Enrollment ID: I20221004003973
Medical Identifiers
Medical identifiers for Dr Lastasha R Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1356911325 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
363LF0000X | Nurse Practitioner - Family | SP022131 (Pennsylvania) | Primary |
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 Lastasha R Jackson allows following entities to bill medicare on her behalf.
Entity Name | Pennsylvania Urgent Care Centers, Pllc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1902128721 PECOS PAC ID: 8123200631 Enrollment ID: O20110304000289 |
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Entity Name | Mhp Md Pllc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1508538695 PECOS PAC ID: 6507258423 Enrollment ID: O20220126000747 |
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Entity Name | Rite Med Group Of Pa Pllc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1962118000 PECOS PAC ID: 1254703671 Enrollment ID: O20230214000385 |
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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. Dr Lastasha R 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 |
Dr Lastasha R Jackson, CRNP 330 E Brown St, Norristown, PA 19401-5407 Ph: (484) 213-3591 | Dr Lastasha R Jackson, CRNP 215 Bullens Ln, Woodlyn, PA 19094-2001 Ph: (484) 416-0769 |
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