JACKSON HOSPITAL AND CLINIC INC
NPI 1407387848
Thoracic Surgery (Cardiothoracic Vascular Surgery) in Montgomery, AL

Q: What is Jackson Hospital And Clinic Inc's NPI number?

The NPI number for Jackson Hospital And Clinic Inc is 1407387848. It was assigned to this organization in the NPPES registry on March 27, 2017. The provider is doing business as Jackson Clinic Cardiothoracic Surgery.

Q: What is Jackson Hospital And Clinic Inc's specialty?

The primary specialty registered for this NPI is Thoracic Surgery (Cardiothoracic Vascular Surgery) with taxonomy code 208G00000X.

Active since March 27, 2017

1758 PARK PL, SUITE 202, MONTGOMERY, AL 36106(334) 264-7156(334) 264-7681 Get Directions Write a Review

NPPES record last updated: March 9, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 9, 2026, Mar 27, 2017 (2 updates tracked since 2017).

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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 1407387848), doing business as Jackson Clinic Cardiothoracic Surgery, is a healthcare organization registered as a thoracic surgery (cardiothoracic vascular surgery) in Montgomery, Alabama and active in the NPI registry since March 2017. The organization lists Kelin Penney, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1407387848

Entity TypeOrganization

Primary Taxonomy208G00000X

Legal Business NameJACKSON HOSPITAL AND CLINIC INC

Location Address1758 PARK PL, SUITE 202Montgomery, AL 36106-1127

Mailing Address1722 Pine St Ste 804Montgomery, AL 36106-1108 · (334) 293-8736 · Fax (334) 293-8738

Phone(334) 264-7156

Fax(334) 264-7681

Organization SubpartNo

Authorized OfficialKelin PenneyExecutive Director · (334) 240-2335

Enumeration DateMarch 27, 2017

Last NPPES UpdateMarch 9, 20262 updates tracked since enumeration

NPPES CertifiedMarch 9, 2026

✔ NPI 1407387848 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyThoracic Surgery (Cardiothoracic Vascular Surgery)Allopathic & Osteopathic Physicians

Taxonomy Code208G00000X

Definition

A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty.

1758 PARK PL, Montgomery, AL 36106

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Other Names 1

Doing Business AsJackson Clinic Cardiothoracic Surgery

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-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)

Jackson Hospital And Clinic Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

247

Medicare 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 167 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 26

Nurse Practitioner86

Internal Medicine39

Family Practice26

Cardiovascular Disease (Cardiology)10

General Surgery9

Hospitalist8

Otolaryngology8

Urology7

18 other specialties54

Nearest to this location (20)

See all 247

Ravichandra Boyella, M.D

Cardiovascular Disease (Cardiology)

NPI 1104021567

1758 PARK PL STE 401
Montgomery, AL 36106

(334) 264-9191

✔ PECOS✔ Accepts MedicareSame address

Mary Brock, CRNP, FNP-C

Nurse Practitioner

NPI 1467304931

1758 PARK PL STE 401
Montgomery, AL 36106

(334) 264-9191

✔ PECOSSame address

Andrea Steinbrink Virk, CRNP

Nurse Practitioner

NPI 1710470554

1758 PARK PL STE 406
Montgomery, AL 36106

(334) 240-2348

✔ PECOS✔ Accepts MedicareSame address

Maegan Allen, CRNP

Nurse Practitioner

NPI 1598339038

1758 PARK PL STE 201
Montgomery, AL 36106

(334) 263-3630

✔ PECOS✔ Accepts MedicareSame address

Janet Baumann, CRNP

Nurse Practitioner

NPI 1053750315

1758 PARK PL STE 100
Montgomery, AL 36106

(334) 265-8455

✔ PECOS✔ Accepts MedicareSame address

Tressa Bolton, CRNP

Nurse Practitioner

NPI 1306376694

1758 PARK PL STE 300
Montgomery, AL 36106

(334) 293-8922

✔ PECOS✔ Accepts MedicareSame address

Latoya Clark, MD

Obstetrics/Gynecology

NPI 1346566700

1758 PARK PL SUITE 406
Montgomery, AL 36106

(251) 716-4744

✔ PECOS✔ Accepts MedicareSame address

Jennifer Farrior, CRNP

Nurse Practitioner

NPI 1467166975

1758 PARK PL STE 300
Montgomery, AL 36106

(334) 293-8922

✔ PECOS✔ Accepts MedicareSame address

Amy Jones, WHNP-BC

Nurse Practitioner

NPI 1528690542

1758 PARK PLACE SUITE 301
Montgomery, AL 36106

(334) 240-2335

✔ PECOS✔ Accepts MedicareSame address

Oluwagbenga Koriko, CRNP

Nurse Practitioner

NPI 1427875475

1758 PARK PL STE 300
Montgomery, AL 36106

(334) 293-8922

✔ PECOS✔ Accepts MedicareSame address

Justin Parden, M.D.

Vascular Surgery

NPI 1578790895

1758 PARK PL STE 300
Montgomery, AL 36106

(334) 293-8922

✔ PECOS✔ Accepts MedicareSame address

Crystal Reese

Obstetrics/Gynecology

NPI 1780003822

1758 PARK PL STE 301
Montgomery, AL 36106

(334) 284-1500

✔ PECOS✔ Accepts MedicareSame address

Ernestine Takang, CRNP

Nurse Practitioner

NPI 1619554755

1758 PARK PL STE 401
Montgomery, AL 36106

(334) 264-9191

✔ PECOSSame address

William Veale, MD, MPH

Vascular Surgery

NPI 1093992646

1758 PARK PL STE 300
Montgomery, AL 36106

(334) 293-8922

✔ PECOS✔ Accepts MedicareSame address

Raymond Wheat, CRNP

Nurse Practitioner

NPI 1992438071

1758 PARK PL STE 406
Montgomery, AL 36106

(334) 240-2348

✔ PECOS✔ Accepts MedicareSame address

Pamela Beams, DO

Otolaryngology

NPI 1750764221

1111 OLIVE ST
Montgomery, AL 36106

(334) 834-7221

✔ PECOS✔ Accepts MedicareSame address

Andrew Ford, MD

Otolaryngology

NPI 1164411963

1111 OLIVE ST
Montgomery, AL 36106

(334) 834-7221

✔ PECOSSame address

Jade Hoy, D.O.

Family Practice

NPI 1528268703

1111 OLIVE STREET
Montgomery, AL 36106

(334) 293-8888

✔ PECOS✔ Accepts MedicareSame address

Ezmina Lalani, D.O.

Internal Medicine

NPI 1831407964

1111 OLIVE ST
Montgomery, AL 36106

(334) 293-8888

✔ PECOS✔ Accepts MedicareSame address

Blake Raggio, MD

Otolaryngology

NPI 1497174189

1111 OLIVE ST
Montgomery, AL 36106

(334) 834-7221

✔ PECOSSame address

See all 247 clinicians

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

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 Jackson Hospital And Clinic Inc's NPI number?

The NPI number for Jackson Hospital And Clinic Inc is 1407387848. It was assigned to this organization in the NPPES registry on March 27, 2017. The provider is doing business as Jackson Clinic Cardiothoracic Surgery.

Where is Jackson Hospital And Clinic Inc located?

Jackson Hospital And Clinic Inc is located at 1758 Park Pl Suite 202, Montgomery, AL 36106. The listed phone number is (334) 264-7156.

What is Jackson Hospital And Clinic Inc's specialty?

The primary specialty registered for this NPI is Thoracic Surgery (Cardiothoracic Vascular Surgery) with taxonomy code 208G00000X.

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 167 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.