JONATHAN D JACKSON (FNP-BC) – Family Nurse Practitioner, NPI 1104553924

JONATHAN D JACKSON (FNP-BC) is a healthcare provider. based in Ringgold, Georgia. specializing in NURSE PRACTITIONER. They hold the professional credentials FNP-BC. They hold a License No. RN162421 (GA). The NPI Number for JONATHAN D JACKSON (FNP-BC) is 1104553924

Main info

Male
6 Years Of Experience
Accepts Medicare Assignment
Name
JONATHAN D JACKSON (FNP-BC)
NPI
1104553924
Phone
(423) 902-9979
Address
25 TRANQUIL LN
Enumeration Date
2 August 2022
Last Update Date
2 August 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4234581426
Graduation Year
2020 (6 years ago)
PAC ID
0042680647
Group Practice PAC ID
7719131101
Professional Enrollment ID
I20240611000673
Address ID
TN374213124CH1521XRDXX301
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience30
Completeness75
Years active:3State licenses:1Digital endpointsOther names

9,658 NURSE PRACTITIONER in GA

Provider Addresses for JONATHAN D JACKSON (FNP-BC)

  • 25 TRANQUIL LN

    RINGGOLD, GA 307362859

    Phone: (423) 902-9979

    Mailing address matches the actual address.

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: 2024-06-11

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20221222001685INurse PractitionerGATBD
I20240611000673INurse PractitionerTNTBD

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.

Verify on CMS Revalidation Lookup Tool

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99285Emergency department visit with high level of medical decision making147142$0
99284Emergency department visit with moderate level of medical decision making3535$0
View full utilization report →

Insurance plans in this area (ZIP 30736)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 7719131101View full group profile
NameSpecialtyState
Nurse PractitionerTN
-TN
Nurse PractitionerTN
Nurse PractitionerTN
-TN
Family PracticeNC
Physician AssistantTN
Family PracticeWI
Physician AssistantMD
Nurse PractitionerTN

Reviews

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Frequently asked questions

What NPI should I save for JONATHAN D JACKSON (FNP-BC)?
Save NPI 1104553924 if you need a stable reference for JONATHAN D JACKSON (FNP-BC).
Does this profile mean JONATHAN D JACKSON (FNP-BC) is currently active?
Yes — JONATHAN D JACKSON (FNP-BC) appears active in the national provider directory.
What field does JONATHAN D JACKSON (FNP-BC) work in?
You can think of JONATHAN D JACKSON (FNP-BC) as practicing within Family Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Where does public data place JONATHAN D JACKSON (FNP-BC)?
The snapshot lists Ringgold, Georgia for JONATHAN D JACKSON (FNP-BC); download NPPES for the complete set.
What if Ringgold, Georgia seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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