JACKSON HOSPITAL AND CLINIC INC.
NPI 1194261669
Internal Medicine - Cardiovascular Disease in Montgomery, AL
About Jackson Hospital And Clinic Inc. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACKSON HOSPITAL AND CLINIC INC. (NPI 1194261669), doing business as Jackson Clinic Cardiology Suite 402, is a healthcare organization registered as a cardiovascular disease in Montgomery, Alabama and active in the NPI registry since January 2017. The organization holds a CLIA Waiver certificate valid through May 10, 2027 and lists Kelin Penney, Executive Director, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jackson Hospital And Clinic Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
247Medicare enrollment records show 247 clinicians reassign Medicare billing to Jackson Hospital And Clinic Inc., which bills Medicare for the services they deliver. Of these, 22 practice at this address and 166 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 26
Nearest to this location (20)
See all 247Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 01D2130568
Jackson Hospital & Clinic Inc · Montgomery, ALFrequently 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 Jackson Hospital And Clinic Inc.'s NPI number?
The NPI number for Jackson Hospital And Clinic Inc. is 1194261669. It was assigned to this organization in the NPPES registry on January 9, 2017. The provider is doing business as Jackson Clinic Cardiology Suite 402.
Where is Jackson Hospital And Clinic Inc. located?
Jackson Hospital And Clinic Inc. is located at 1758 Park Pl Suite 402, Montgomery, AL 36106. The listed phone number is (334) 293-6842.
What is Jackson Hospital And Clinic Inc.'s specialty?
The primary specialty registered for this NPI is Internal Medicine, specializing in Cardiovascular Disease, with taxonomy code 207RC0000X.
Is Jackson Hospital And Clinic Inc. enrolled in Medicare?
Yes. Jackson Hospital And Clinic Inc. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Jackson Hospital And Clinic Inc.?
According to the CMS Revalidation Reassignment List (October 2026 release), 247 clinicians in 26 Medicare specialties reassign their Medicare billing to Jackson Hospital And Clinic Inc.. A 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 the clinician's services. The largest specialties are Nurse Practitioner (86), Internal Medicine (39) and Family Practice (26). Of these, 22 practice at this address and 166 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Jackson Hospital And Clinic Inc. hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 01D2130568) is associated with this NPI, valid through May 10, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Jackson Hospital And Clinic Inc. was last updated on March 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months 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.
# Jackson Hospital And Clinic Inc. · NPI 1194261669
Cardiovascular Disease organization in Montgomery, Alabama. Organization record, active in the CMS NPPES registry since January 9, 2017.
## Identity
- **NPI:** 1194261669 (Entity type: Organization)
- **Enumerated:** January 9, 2017
- **Primary specialty:** Internal Medicine - Cardiovascular Disease · taxonomy 207RC0000X
- **Also known as:** Jackson Clinic Cardiology Suite 402 (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Kelin Penney, EXECUTIVE DIRECTOR
## Practice location
- **Address:** 1758 PARK PL, SUITE 402, Montgomery, AL 36106-1127
- **Phone:** (334) 293-6842 · **Fax:** (334) 293-6843
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 247 clinicians in 26 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (86), Internal Medicine (39), Family Practice (26); 22 practice at this address and 166 within 10 miles; [full list](https://npiprofile.com/npi/1194261669/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 9, 2026
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1194261669) · Data from the CMS NPPES public registry.