MRS. PENNI F JACKSON (PAC) – Medical Physician Assistant, NPI 1023103397
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,396 PHYSICIAN ASSISTANT in NE
Provider Addresses for MRS. PENNI F JACKSON (PAC)
4445 S 86th St # 100
Lincoln, NE 685269225
Phone: (402) 414-4200
Fax: (402) 414-4202
Type: Location
Autumn Ridge Medical Center, 5000, North 26th Street, Elizabeth Park North, Lincoln, Lancaster County, Nebraska, 68521, United States
SUITE 200
LINCOLN, NE 685214749
Phone: (402) 475-6656
Fax: (402) 741-8418
Type: Location
South 86th Street, Rokeby Ridge, Lincoln, Lancaster County, Nebraska, 68516, United States
LINCOLN, NE 685269225
Phone: (402) 414-4200
Fax: (402) 414-4202
Type: Mailing
6940 VAN DORN ST STE 201
LINCOLN, NE 685062858
Phone: (402) 413-6363
Fax: (402) 512-9133
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $29.
Total Amount is formed as General ($29) + Research ($0) + Ownership ($0) = $29.
Last reported payment date: 2024-12-06 • Largest payer in this snapshot: Novartis Pharmaceuticals Corporation ($16).
Total Amount
$29
General + Research + Ownership
Payments
2
Total payment records
General Amount
$29
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-06
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Novartis Pharmaceuticals Corporation | $16 |
| Amgen Inc. | $13 |
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: 2004-04-26
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 |
|---|---|---|---|---|
| I20040426001080 | I | Physician Assistant | NE | 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 68526)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Cardiovascular Disease (Cardiology), Interventional Cardiology, Cardiovascular Disease (Cardiology), Internal Medicine | NE | |
| Nurse Practitioner | NE | |
| Nurse Practitioner | NE | |
| - | NE | |
| Nurse Practitioner | NE | |
| Cardiovascular Disease (Cardiology) | NE |
Reviews
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