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MRS. KAITLYN HANSEN JACKSON MSN, CPNP-PC, RN
NPI 1538704622
Nurse Practitioner - Pediatrics in New York, NY

Active since November 12, 2019PECOS Enrolled
801 AMSTERDAM AVE, NEW YORK, NY 10025(212) 749-1820 Get Directions Write a Review

NPPES record last updated: December 1, 2025. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Dec 1, 2025, Nov 12, 2019 (2 updates tracked since 2019).

About Mrs. Kaitlyn Hansen Jackson Msn, Cpnp-pc, Rn NPPES

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

MRS. KAITLYN HANSEN JACKSON MSN, CPNP-PC, RN (NPI 1538704622) is an individual pediatrics provider in New York, New York, licensed in New York (383070) and active in the NPI registry since November 2019. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1538704622
Entity TypeIndividualFemale
Primary Taxonomy363LP0200X
Provider Legal NameMRS. KAITLYN HANSEN JACKSONCredential: MSN, CPNP-PC, RN
Location Address801 AMSTERDAM AVENew York, NY 10025-5752
Mailing Address110 W 97th StNew York, NY 10025-6450 · (347) 893-6833
Phone(212) 749-1820
Sole ProprietorNo
Enumeration DateNovember 12, 2019
Last NPPES UpdateDecember 1, 20252 updates tracked since enumeration
NPPES CertifiedDecember 1, 2025
✔ NPI 1538704622 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · PediatricsPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0200X
License✔ Licensed in NY · 383070
801 AMSTERDAM AVE, New York, NY 10025
Open in Google Maps ↗

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Kaitlyn Hansen Jackson Msn, Cpnp-pc, Rn 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 Kaitlyn Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

William F Ryan Community Health Center Inc
Same address
Federally Qualified Health Center (FQHC)
801 AMSTERDAM AVE
New York, NY 10025
  • Reassigned Medicare billing, New York enrollment
  • 186 clinicians in this Medicare group
NPI 1124347182 (212) 749-1820

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 10025 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
$102.04 typical visit price
range $65.69 – $198.19
Typical copayment $25.51 (range $16.42 – $49.54)
Most-billed visit code 99203
Established Patient
$114.88 typical visit price
range $21.20 – $160.66
Typical copayment $28.72 (range $5.30 – $40.16)
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 20

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

MS. LESLIE ANN SANTANA LMSW
Social Worker
801 AMSTERDAM AVE
NEW YORK, NY 10025
New York County (212) 769-7200
RAMESH GADDE
Pharmacist
801 AMSTERDAM AVE
NEW YORK, NY 10025
New York County (212) 678-0084
VICTORIA DELGADO DO
Obstetrics & Gynecology
801 AMSTERDAM AVE
NEW YORK, NY 10025
New York County (212) 316-8300
AMISHA JAIMON
Pharmacist
801 AMSTERDAM AVE
NEW YORK, NY 10025
New York County (212) 678-0084
NICOLE MARIE MARONA LCSW
Social Worker (Clinical)
801 AMSTERDAM AVE
NEW YORK, NY 10025
New York County (212) 316-8300
CHARLEA BROOKE MUNOZ LMSW
Social Worker
801 AMSTERDAM AVE
NEW YORK, NY 10025
New York County (646) 543-5026
LYDIA RADZIUL LMSW
Social Worker (Clinical)
801 AMSTERDAM AVE
NEW YORK, NY 10025
New York County (212) 316-8300
CHRISTINA MOHR MD
Pediatrics
801 AMSTERDAM AVE
NEW YORK, NY 10025
New York County (212) 749-1820

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 Kaitlyn Jackson's NPI number?

The NPI number for Kaitlyn Jackson is 1538704622. It was assigned to this individual provider in the NPPES registry on November 12, 2019.

Where is Kaitlyn Jackson located?

Kaitlyn Jackson practices at 801 Amsterdam Ave, New York, NY 10025. The listed phone number is (212) 749-1820.

What is Kaitlyn Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.

Is Kaitlyn Jackson enrolled in Medicare?

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

Which organization bills Medicare for Kaitlyn Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kaitlyn Jackson reassigns Medicare benefits to William F Ryan Community Health Center Inc (New York, NY). 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 Kaitlyn 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 Kaitlyn Jackson was last updated on December 1, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.