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KELLY L DONNELL-JACKSON RN, MSN, APN-C
NPI 1649475765
Nurse Practitioner - Family in Mount Laurel, NJ

Active since June 19, 2007PECOS Enrolled
1015 BRIGGS RD, MOUNT LAUREL, NJ 08054(856) 727-0900(856) 231-8428 Get Directions Write a Review

NPPES record last updated: October 20, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Oct 20, 2020, Jun 24, 2020 (2 updates tracked since 2020).

About Kelly L Donnell-jackson Rn, Msn, Apn-c NPPES

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

KELLY L DONNELL-JACKSON RN, MSN, APN-C (NPI 1649475765) is an individual family provider in Mount Laurel, New Jersey, licensed in New Jersey (26NJ00060400) and active in the NPI registry since June 2007. She is enrolled in Medicare PECOS and maintains a secondary practice location in Sewell.

NPPES Registry Identity

NPI1649475765
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameKELLY L DONNELL-JACKSONCredential: RN, MSN, APN-C
Location Address1015 BRIGGS RDMount Laurel, NJ 08054-4115
Mailing Address301 Lippincott Dr Ste 410Marlton, NJ 08053-4197 · (856) 355-0340 · Fax (856) 355-0330
Phone(856) 727-0900
Fax(856) 231-8428
Sole ProprietorNo
Enumeration DateJune 19, 2007
Last NPPES UpdateOctober 20, 20202 updates tracked since enumeration
NPPES CertifiedOctober 20, 2020
✔ NPI 1649475765 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in NJ · 26NJ00060400
Also ListedRegistered NurseTaxonomy 163W00000X · License 26NR09192400 (NJ)
Also ListedNurse PractitionerTaxonomy 363L00000X · License SP010454 (PA)
1015 BRIGGS RD, Mount Laurel, NJ 08054
Open in Google Maps ↗

Secondary Practice Location 1

Location 167 Stratton LnSewell, NJ 08080-2253 · Phone (856) 889-9577 · Fax (856) 753-7714

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly L Donnell-jackson Rn, Msn, Apn-c 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 Reassignments

3

Medicare enrollment records show Kelly Donnell-jackson reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Virtua Medical Group, PA
2.3 mi
Urgent Care
401 YOUNG AVE STE 180 FRONT
Moorestown, NJ 08057
  • Reassigned Medicare billing, New Jersey enrollment
  • 2,074 clinicians in this Medicare group
NPI 1184174849 (856) 291-8600
Endocrinology Associates, LLC
19 mi
Endocrinology, Diabetes & Metabolism
3 VILLAGE ROAD, STE 10
Horsham, PA 19044
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 2 clinicians in this Medicare group
NPI 1104025709 (215) 657-5500
Princeton Endocrinology Associates, LLC
30 mi
Specialist
10 FORRESTAL RD S STE 202
Princeton, NJ 08540
  • Reassigned Medicare billing, New Jersey enrollment
  • 3 clinicians in this Medicare group
NPI 1356587505 (609) 921-1511

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

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
141 services82 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
54 services40 patients
Continuous monitoring of blood sugar level in tissue fluid using sensor under skin with interpretation and report 95251
This procedure involves placing a small sensor under your skin to continuously monitor your blood sugar levels in tissue fluid. The data is interpreted and a report is generated to help manage your diabetes more effectively.
48 services30 patients
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
41 services37 patients
Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212
This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.
26 services24 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
12 services12 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 08054 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
$94.90 typical visit price
range $61.59 – $185.05
Typical copayment $23.72 (range $15.39 – $46.26)
Most-billed visit code 99203
Established Patient
$107.94 typical visit price
range $20.08 – $150.98
Typical copayment $26.98 (range $5.02 – $37.74)
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.

Referred Medical Equipment & Supplies CMS DME claims 3

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
27 suppliers61 claims223 services$5.90 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
14 suppliers35 claims74 services$1.03 avg. paid by Medicare
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
15 suppliers243 claims244 services$190.74 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 2

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

CHRISTINA MARIA GRANATO
Behavior Technician
1015 BRIGGS RD
MOUNT LAUREL, NJ 08054
Burlington County (856) 492-1355
TYMIR GUNN
Behavior Technician
1015 BRIGGS RD
MOUNT LAUREL, NJ 08054
Burlington County (856) 492-1355

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 Kelly Donnell-jackson's NPI number?

The NPI number for Kelly Donnell-jackson is 1649475765. It was assigned to this individual provider in the NPPES registry on June 19, 2007.

Where is Kelly Donnell-jackson located?

Kelly Donnell-jackson practices at 1015 Briggs Rd, Mount Laurel, NJ 08054. The listed phone number is (856) 727-0900.

What is Kelly Donnell-jackson's specialty?

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

Is Kelly Donnell-jackson enrolled in Medicare?

Yes. Kelly Donnell-jackson is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Kelly Donnell-jackson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Donnell-jackson reassigns Medicare benefits to 3 organizations: Virtua Medical Group, PA (Moorestown, NJ), Endocrinology Associates, LLC (Horsham, PA) and Princeton Endocrinology Associates, LLC (Princeton, NJ). Each 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 Kelly Donnell-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 Kelly Donnell-jackson was last updated on October 20, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.