DOUGLAS JACKSON (NP) – Acute Care Nurse Practitioner, NPI 1184277857
Acute Care Nurse Practitioner
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
14,984 NURSE PRACTITIONER in OH
Provider Addresses for DOUGLAS JACKSON (NP)
3533 Southern Blvd Ste 5650
Kettering, OH 454291263
Phone: (937) 294-3611
Fax: (937) 294-9010
Type: Location
Reid Health, 1100, Reid Parkway, Richmond, Wayne County, Indiana, 47374, United States
MEDICAL STAFF SERVICE
RICHMOND, IN 47374
Phone: (765) 935-5331
Fax: (765) 983-3219
Type: Mailing
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 $94.
Total Amount is formed as General ($94) + Research ($0) + Ownership ($0) = $94.
Last reported payment date: 2024-06-04 • Largest payer in this snapshot: ABBVIE INC. ($79).
Total Amount
$94
General + Research + Ownership
Payments
2
Total payment records
General Amount
$94
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-06-04
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $79 |
| Axsome Therapeutics, Inc. | $14 |
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: 2021-02-02
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 |
|---|---|---|---|---|
| I20210202001241 | I | Nurse Practitioner | OH | 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 45429)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | OH | |
| Internal Medicine, Critical Care (Intensivists) | OH | |
| Pulmonary Disease, Internal Medicine, Sleep Medicine | IN | |
| Nurse Practitioner | PA | |
| Internal Medicine | NJ | |
| Internal Medicine | MD | |
| Physician Assistant | OH | |
| Nurse Practitioner | OH | |
| Internal Medicine | OK |
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