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JASMINE SHANAE JACKSON NP
NPI 1578112496
Nurse Practitioner - Family in Petersburg, VA

Active since September 04, 2019PECOS Enrolled
3400 S CRATER RD STE B, PETERSBURG, VA 23805(804) 733-6960 Get Directions Write a Review

NPPES record last updated: September 6, 2019. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Jasmine Shanae Jackson Np NPPES

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

JASMINE SHANAE JACKSON NP (NPI 1578112496) is an individual family provider in Petersburg, Virginia, licensed in Virginia (0024178156) and active in the NPI registry since September 2019. She is enrolled in Medicare PECOS and maintains a secondary practice location in Henrico.

NPPES Registry Identity

NPI1578112496
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameJASMINE SHANAE JACKSONCredential: NP
Location Address3400 S CRATER RD STE BPetersburg, VA 23805
Mailing Address3400 S Crater Rd Ste BPetersburg, VA 23805-9252 · (804) 733-6960
Phone(804) 733-6960
Sole ProprietorNo
Enumeration DateSeptember 4, 2019
Last NPPES UpdateSeptember 6, 2019
✔ NPI 1578112496 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in VA · 0024178156
3400 S CRATER RD STE B, Petersburg, VA 23805
Open in Google Maps ↗

Secondary Practice Location 1

Location 19000 Staples Mill RdHenrico, VA 23228-2021 · Phone (804) 977-9526

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jasmine Shanae Jackson Np 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 Jasmine Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Virta Medical P.C.
2,451 mi
Internal Medicine
655 MONTGOMERY ST STE 810
San Francisco, CA 94111
  • Reassigned Medicare billing, New Hampshire, Utah, Virginia and West Virginia enrollments
  • Medicare enrollment name: Virta Medical PC
  • 7 clinicians in this Medicare group
NPI 1093225138 (844) 847-8216

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 23805 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
$86.88 typical visit price
range $56.19 – $170.30
Typical copayment $21.72 (range $14.04 – $42.57)
Most-billed visit code 99203
Established Patient
$99.13 typical visit price
range $18.07 – $138.91
Typical copayment $24.78 (range $4.51 – $34.72)
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 Jasmine Jackson's NPI number?

The NPI number for Jasmine Jackson is 1578112496. It was assigned to this individual provider in the NPPES registry on September 4, 2019.

Where is Jasmine Jackson located?

Jasmine Jackson practices at 3400 S Crater Rd Ste B, Petersburg, VA 23805. The listed phone number is (804) 733-6960.

What is Jasmine Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Jasmine Jackson enrolled in Medicare?

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

Which organization bills Medicare for Jasmine Jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jasmine Jackson reassigns Medicare benefits to Virta Medical P.C. (San Francisco, 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 Jasmine 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 Jasmine Jackson was last updated on September 6, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.