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KARISSA KEAGAN JACKSON ACNPC-AG
NPI 1164055109
Nurse Practitioner - Acute Care in Park City, UT

Active since February 18, 2020PECOS Enrolled
1776 PARK AVE STE 211, PARK CITY, UT 84060(385) 464-3980(385) 464-3990 Get Directions Write a Review

NPPES record last updated: June 2, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Oct 13, 2020, Sep 14, 2020, Feb 18, 2020 (3 updates tracked since 2020).

About Karissa Keagan Jackson Acnpc-ag NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KARISSA KEAGAN JACKSON ACNPC-AG (NPI 1164055109) is an individual acute care provider in Park City, Utah, licensed in Utah (7120828-4405) and active in the NPI registry since February 2020. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1164055109
Entity TypeIndividualFemale
Primary Taxonomy363LA2100X
Provider Legal NameKARISSA KEAGAN JACKSONCredential: ACNPC-AG
Location Address1776 PARK AVE STE 211Park City, UT 84060-5148
Mailing Address1776 Park Ave Ste 211Park City, UT 84060-5148 · (385) 464-3980 · Fax (385) 464-3990
Phone(385) 464-3980
Fax(385) 464-3990
Sole ProprietorNo
Enumeration DateFebruary 18, 2020
Last NPPES UpdateJune 2, 20243 updates tracked since enumeration
NPPES CertifiedMarch 8, 2023
✔ NPI 1164055109 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2100X
License✔ Licensed in UT · 7120828-4405
1776 PARK AVE STE 211, Park City, UT 84060
Open in Google Maps ↗

Other Names 1

Former Name (1)Karissa Keagan Jungerman

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Karissa Keagan Jackson Acnpc-ag is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Karissa Jackson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Ihc Health Services
0.2 mi
Birthing
1200 IRON HORSE DR
Park City, UT 84060
  • Reassigned Medicare billing, Utah enrollment
  • 1,729 clinicians in this Medicare group
NPI 1134244213 (801) 442-1400
Neurosurgical Associates LLC
20 mi
Neurological Surgery
5171 COTTONWOOD ST, # 950
Murray, UT 84107
  • Reassigned Medicare billing, Utah enrollment
  • 13 clinicians in this Medicare group
NPI 1477695187 (801) 507-9555

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84060 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.41 typical visit price
range $54.34 – $166.03
Typical copayment $21.10 (range $13.58 – $41.50)
Most-billed visit code 99203
Established Patient
$96.35 typical visit price
range $17.23 – $135.20
Typical copayment $24.08 (range $4.30 – $33.80)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

APOLONIA G. SILVA FNP
Nurse Practitioner (Family)
1776 PARK AVE STE 211
PARK CITY, UT 84060
Summit County (385) 464-3980

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Karissa Jackson's NPI number?

The NPI number for Karissa Jackson is 1164055109. It was assigned to this individual provider in the NPPES registry on February 18, 2020. The provider is also known as Karissa Keagan Jungerman.

Where is Karissa Jackson located?

Karissa Jackson practices at 1776 Park Ave Ste 211, Park City, UT 84060. The listed phone number is (385) 464-3980.

What is Karissa Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.

Is Karissa Jackson enrolled in Medicare?

Yes. Karissa Jackson is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Karissa Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Karissa Jackson reassigns Medicare benefits to 2 organizations: Ihc Health Services (Park City, UT) and Neurosurgical Associates LLC (Murray, UT). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Karissa Jackson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Karissa Jackson was last updated on June 2, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.