BRENT JACKSON – Acute Care Nurse Practitioner, NPI 1245967405

BRENT JACKSON is a healthcare provider. based in Tuttle, Oklahoma. specializing in NURSE PRACTITIONER. They hold a License No. 96391 (OK). The NPI Number for BRENT JACKSON is 1245967405

Main info

Male
Sole Proprietor
4 Years Of Experience
Accepts Medicare Assignment
Name
BRENT JACKSON
NPI
1245967405
Phone
Not provided
Address
2377 COUNTY ROAD 1201
Enumeration Date
6 August 2022
Last Update Date
4 September 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4156006000
Graduation Year
2022 (4 years ago)
PAC ID
4981077302
Group Practice PAC ID
3476506528
Professional Enrollment ID
I20240509001798
Address ID
CA941104403SA3555XCHAV300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience39
Completeness75
Years active:3State licenses:2Digital endpointsOther names

3,299 NURSE PRACTITIONER in OK

Provider Addresses for BRENT JACKSON

  • 2377 COUNTY ROAD 1201

    TUTTLE, OK 730891067

    Phone:

    Mailing address matches the actual address.

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: 2024-05-09

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240509001798INurse PractitionerCATBD

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.

Verify on CMS Revalidation Lookup Tool

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99221Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes4242$0
99222Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes3333$0
99291Critical care, first 30-74 minutes1616$0
View full utilization report →

Insurance plans in this area (ZIP 73089)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3476506528View full group profile
NameSpecialtyState
-CA
Nurse PractitionerCA
Cardiovascular Disease (Cardiology), Nuclear Medicine, Internal MedicineCA
O B S T E T R I C S/ G Y N E C O L O G YCA
Physician AssistantCA
Nurse PractitionerTN
Orthopedic SurgeryCA
-CA
Nurse PractitionerCA
Nurse PractitionerCA

Reviews

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Frequently asked questions

Is BRENT JACKSON listed with a National Provider Identifier?
Yes — BRENT JACKSON has NPI 1245967405 on file in the registry.
Active or inactive — what applies to BRENT JACKSON?
You should see BRENT JACKSON as active in CMS-hosted NPPES data.
What area of care is associated with BRENT JACKSON?
BRENT JACKSON's record emphasizes Acute Care Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Is BRENT JACKSON associated with Tuttle?
Public fields place BRENT JACKSON around Tuttle, Oklahoma. Always confirm the exact site before visiting.
When was this NPI issued?
Enumeration for BRENT JACKSON is noted as August 6, 2022 where the registry provides it.

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