MRS. TIFFANY R JACKSON (NP) – Nurse Practitioner, NPI 1093066086
Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
8,106 NURSE PRACTITIONER in MI
Provider Addresses for MRS. TIFFANY R JACKSON (NP)
100 MICHIGAN ST NE
MC 845
GRAND RAPIDS, MI 495032560
Phone:
Type: Mailing
1108 W STATE ST
SUITE 3
HASTINGS, MI 490589711
Phone: (269) 945-0922
Fax: (269) 945-4511
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 194 Open Payments records for all available years, with a total value of $3,097.
Total Amount is formed as General ($3,097) + Research ($0) + Ownership ($0) = $3,097.
Last reported payment date: 2024-12-20 • Largest payer in this snapshot: Novo Nordisk Inc ($456).
Total Amount
$3,097
General + Research + Ownership
Payments
194
Total payment records
General Amount
$3,097
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-20
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Novo Nordisk Inc | $456 |
| ABBVIE INC. | $382 |
| AstraZeneca Pharmaceuticals LP | $341 |
| Lilly USA, LLC | $269 |
| PFIZER INC. | $268 |
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: 2013-12-05
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 |
|---|---|---|---|---|
| I20131205000687 | I | Nurse Practitioner | MI | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 70 | 49 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 45 | 45 | $0 |
| G0444 | Annual depression screening, 5 to 15 minutes | 44 | 44 | $0 |
| 83036 | Hemoglobin a1c level | 33 | 26 | $0 |
| 36415 | Insertion of needle into vein for collection of blood sample | 22 | 19 | $0 |
Insurance plans in this area (ZIP 49503)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | MI | |
| - | MI | |
| Nurse Practitioner | MI | |
| Family Practice | MI | |
| Nurse Practitioner | MI |
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