HEATHER MARIA JACKSON (D.O.) – Family Medicine Physician, NPI 1104034008
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for HEATHER MARIA JACKSON (D.O.)
4700 SMITH RD
STE A
CINCINNATI, OH 452122787
Phone: (513) 533-1199
Fax: (513) 533-6000
Type: Mailing
PriMed Physicians, 2322, Lakeview Drive, Beavercreek, Greene County, Ohio, 45431, United States
BEAVERCREEK, OH 454312772
Phone: (937) 426-0106
Fax: (937) 426-7153
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: 2022-03-24
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 |
|---|---|---|---|---|
| I20220324000372 | I | Family Practice | 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 45212)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MI | |
| U R O L O G Y | MI | |
| - | MI | |
| - | MI | |
| Cardiac Electrophysiology, Cardiovascular Disease (Cardiology) | MI | |
| - | MI | |
| Physician Assistant | OH | |
| - | MI | |
| - | MI | |
| - | MI |
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