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BRENT JACKSON
NPI 1245967405
Nurse Practitioner - Acute Care in Tuttle, OK

Active since August 06, 2022PECOS Enrolled
2377 COUNTY ROAD 1201, TUTTLE, OK 73089(405) 412-3213 Get Directions Write a Review

NPPES record last updated: September 4, 2022. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Sep 4, 2022, Aug 6, 2022 (2 updates tracked since 2022).

About Brent Jackson NPPES

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

BRENT JACKSON (NPI 1245967405) is an individual acute care provider in Tuttle, Oklahoma, licensed in Oklahoma (210172) and active in the NPI registry since August 2022. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1245967405
Entity TypeIndividualMale
Primary Taxonomy363LA2100X
Provider Legal NameBRENT JACKSON
Location Address2377 COUNTY ROAD 1201Tuttle, OK 73089-1067
Mailing Address2377 County Road 1201Tuttle, OK 73089-1067
Phone(405) 412-3213
Sole ProprietorYes
Enumeration DateAugust 6, 2022
Last NPPES UpdateSeptember 4, 20222 updates tracked since enumeration
NPPES CertifiedSeptember 4, 2022
✔ NPI 1245967405 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2100X
License✔ Licensed in OK · 210172
Also ListedRegistered NurseTaxonomy 163W00000X · License 96391 (OK)
2377 COUNTY ROAD 1201, Tuttle, OK 73089
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Brent Jackson 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 Reassignment

Medicare enrollment records show Brent Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Sutter Bay Hospitals
1,358 mi
General Acute Care Hospital
20103 LAKE CHABOT ROAD
Castro Valley, CA 94546
  • Reassigned Medicare billing, California enrollment
  • 132 clinicians in this Medicare group
NPI 1063812907 (510) 537-1234

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 73089 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
$82.46 typical visit price
range $53.00 – $162.61
Typical copayment $20.61 (range $13.25 – $40.65)
Most-billed visit code 99203
Established Patient
$94.27 typical visit price
range $16.68 – $132.40
Typical copayment $23.56 (range $4.17 – $33.10)
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.

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 Brent Jackson's NPI number?

The NPI number for Brent Jackson is 1245967405. It was assigned to this individual provider in the NPPES registry on August 6, 2022.

Where is Brent Jackson located?

Brent Jackson practices at 2377 County Road 1201, Tuttle, OK 73089. The listed phone number is (405) 412-3213.

What is Brent Jackson's specialty?

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

Is Brent Jackson enrolled in Medicare?

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

Which organization bills Medicare for Brent Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Brent Jackson reassigns Medicare benefits to Sutter Bay Hospitals (Castro Valley, CA). The 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 Brent 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 Brent Jackson was last updated on September 4, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.