NIKI ROSE JACKSON (MD) – Internal Medicine Physician, NPI 1083140891
Internal Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
13,290 INTERNAL MEDICINE in TX
Provider Addresses for NIKI ROSE JACKSON (MD)
3032 MARINA BAY DR STE 200
LEAGUE CITY, TX 775734668
Phone: (832) 604-6534
Fax: (832) 604-6531
Type: Location
2727 W Holcombe Blvd
Houston, TX 770251669
Phone: (713) 442-0000
Type: Location
1010 S Ponds Dr
Webster, TX 775981409
Phone: (713) 442-4300
Type: Location
Mayo Clinic Hospital Scottsdale Campus, 13400, East Shea Boulevard, Scottsdale, Maricopa County, Arizona, 85259, United States
SCOTTSDALE, AZ 852595452
Phone: (480) 301-8000
Type: Mailing
11511 SHADOW CREEK PKWY
PEARLAND, TX 775847298
Phone: (713) 442-4997
Type: Mailing
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: 2022-02-03
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 |
|---|---|---|---|---|
| I20220203001065 | I | Internal Medicine | TX | 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 77573)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | TX |
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