LEE DOUGLAS JACKSON (NP-C) – Nurse Practitioner, NPI 1053602102
Nurse Practitioner
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Profile Insights
NPPES metrics only — not quality of care.
24,232 NURSE PRACTITIONER in FL
Provider Addresses for LEE DOUGLAS JACKSON (NP-C)
16271 BASS RD
FORT MYERS, FL 339083616
Phone: (239) 343-7100
Fax: (239) 468-7924
Type: Location
PO BOX 25608
SALT LAKE CITY, UT 841250608
Phone: (206) 320-4476
Fax: (206) 568-7043
Type: Mailing
214 W 1ST ST
CLE ELUM, WA 989221108
Phone: (509) 674-6779
Fax: (509) 674-6896
Type: Location
PO BOX 2147
FORT MYERS, FL 339022147
Phone: (239) 343-9100
Fax: (239) 343-9108
Type: Mailing
214 W 1st St
Cle Elum, WA 989221108
Phone: (509) 674-6779
Fax: (509) 674-6896
Type: Location
9131 College Pointe Ct
Fort Myers, FL 339193245
Phone: (239) 343-9100
Fax: (239) 343-9108
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-01-23
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20160113001197 | I | Nurse Practitioner | WA | TBD |
| I20240123004245 | I | Nurse Practitioner | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 33908)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| R H E U M A T O L O G Y | FL | |
| Nurse Practitioner | FL | |
| Critical Care (Intensivists), Pediatric Medicine | FL | |
| General Surgery | MI | |
| N E U R O L O G Y | MO | |
| Medical Genetics And Genomics | MI | |
| Nurse Practitioner | FL | |
| Family Practice | FL | |
| General Surgery | FL | |
| Family Practice | FL |
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