JACKSON PAYNE – Primary Care Nurse Practitioner, NPI 1194407379
Primary Care Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,410 NURSE PRACTITIONER in AR
Provider Addresses for JACKSON PAYNE
PO BOX 776084
CHICAGO, IL 606776084
Phone: (314) 364-4200
Fax: (314) 364-6321
Type: Mailing
2708 S RIFE MEDICAL LN STE 210
ROGERS, AR 727581456
Phone: (479) 338-3888
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 11 Open Payments records for all available years, with a total value of $237.
Total Amount is formed as General ($237) + Research ($0) + Ownership ($0) = $237.
Last reported payment date: 2024-12-04 • Largest payer in this snapshot: Silk Road Medical, Inc. ($74).
Total Amount
$237
General + Research + Ownership
Payments
11
Total payment records
General Amount
$237
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-04
Latest reported date
Top Companies
Largest payers in this snapshot
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: 2024-01-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
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 |
|---|---|---|---|---|
| I20240130000475 | I | Nurse Practitioner | AR | 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 60677)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| O B S T E T R I C S/ G Y N E C O L O G Y | AR | |
| Internal Medicine, Cardiovascular Disease (Cardiology) | MO | |
| Nurse Practitioner | AR | |
| Internal Medicine, General Practice | AR | |
| - | AR | |
| R H E U M A T O L O G Y | AR | |
| - | AR | |
| - | AR | |
| - | AR | |
| Nurse Practitioner | AR |
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