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MERCY CLINIC OF JACKSON, PLLC
NPI 1306047105
Specialist in Jackson, KY

Active since May 30, 2007CLIA 18D1045802 · Waiver
1550 HIGHWAY 15 S, SUITE 80, JACKSON, KY 41339(606) 693-0343(606) 693-0322 Get Directions Write a Review

NPPES record last updated: October 4, 2007. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Mercy Clinic Of Jackson, Pllc NPPES

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

MERCY CLINIC OF JACKSON, PLLC (NPI 1306047105) is a healthcare organization registered as a specialist in Jackson, Kentucky and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through September 1, 2027 and lists Susan Pratt, Clinic Manager, as its authorized official.

NPPES Registry Identity

NPI1306047105
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameMERCY CLINIC OF JACKSON, PLLC
Location Address1550 HIGHWAY 15 S, SUITE 80Jackson, KY 41339-7247
Mailing Address1550 Highway 15 S, Suite 80Jackson, KY 41339-7247 · (606) 693-0343 · Fax (606) 693-0322
Phone(606) 693-0343
Fax(606) 693-0322
Organization SubpartNo
Authorized OfficialSusan PrattClinic Manager · (606) 693-0343
Enumeration DateMay 30, 2007
Last NPPES UpdateOctober 4, 2007
✔ NPI 1306047105 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in KY · 31497
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
1550 HIGHWAY 15 S, Jackson, KY 41339
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Other Identifiers 1

Medicare ID-Type Unspecified9700KY

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mercy Clinic Of Jackson, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Mercy Clinic Of Jackson, PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Cesar Agtarap, M.D.
Internal Medicine
NPI 1285635698
1550 HIGHWAY 15 S SUITE 80
Jackson, KY 41339
(606) 693-0343
✔ PECOS✔ Accepts Medicare0.5 mi

Source: 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 18D1045802

Mercy Clinic Of Jackson · Jackson, KY
Active · expires Sep 1, 2027
CLIA Number18D1045802
Laboratory TypePhysician Office
Certificate Effective DateSeptember 2, 2025
Certificate Expiration DateSeptember 1, 2027
Laboratory DirectorAida Agtarap-Rynkowski Mt
Laboratory Phone(606) 693-0343
Laboratory LocationMercy Clinic Of Jackson1550 Highway 15 South, Suite 80, Jackson, KY 41339
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Mercy Clinic Of Jackson, PLLC's NPI number?

The NPI number for Mercy Clinic Of Jackson, PLLC is 1306047105. It was assigned to this organization in the NPPES registry on May 30, 2007.

Where is Mercy Clinic Of Jackson, PLLC located?

Mercy Clinic Of Jackson, PLLC is located at 1550 Highway 15 S Suite 80, Jackson, KY 41339. The listed phone number is (606) 693-0343.

What is Mercy Clinic Of Jackson, PLLC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Mercy Clinic Of Jackson, PLLC enrolled in Medicare?

Yes. Mercy Clinic Of Jackson, PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mercy Clinic Of Jackson, PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Mercy Clinic Of Jackson, PLLC. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Mercy Clinic Of Jackson, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 18D1045802) is associated with this NPI, valid through September 1, 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 Mercy Clinic Of Jackson, PLLC was last updated on October 4, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.