COLLEEN A JACKSON
NPI 1669629275
Nutritionist - Nutrition, Education in Patchogue, NY
About Colleen A Jackson NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
COLLEEN A JACKSON (NPI 1669629275) is an individual nutrition, education provider in Patchogue, New York, licensed in New York (004661) and active in the NPI registry since August 2008.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Colleen A Jackson is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Colleen Jackson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Bethpage, NY 11714
- Reassigned Medicare billing, New York enrollment
- 211 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
PATCHOGUE, NY 11772
PATCHOGUE, NY 11772
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 Colleen Jackson's NPI number?
The NPI number for Colleen Jackson is 1669629275. It was assigned to this individual provider in the NPPES registry on August 26, 2008.
Where is Colleen Jackson located?
Colleen Jackson practices at 101 Hospital Rd, Patchogue, NY 11772. The listed phone number is (631) 654-7236.
What is Colleen Jackson's specialty?
The primary specialty registered for this NPI is Nutritionist, specializing in Nutrition, Education, with taxonomy code 133NN1002X.
Is Colleen Jackson enrolled in Medicare?
Yes. Colleen Jackson is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Colleen Jackson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Colleen Jackson reassigns Medicare benefits to St. Joseph Hospital (Bethpage, 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 Colleen 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 Colleen Jackson was last updated on August 26, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.
# Colleen A Jackson · NPI 1669629275
Nutrition, Education provider in Patchogue, New York. Individual provider, active in the CMS NPPES registry since August 26, 2008.
## Identity
- **NPI:** 1669629275 (Entity type: Individual)
- **Enumerated:** August 26, 2008
- **Primary specialty:** Nutritionist - Nutrition, Education · taxonomy 133NN1002X
- **State license:** 004661 (New York)
- **Sole proprietor:** No
## Practice location
- **Address:** 101 HOSPITAL RD, Patchogue, NY 11772-4870
- **Phone:** (631) 654-7236
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Bills Medicare through:** St. Joseph Hospital (NPI 1881799153, Bethpage, NY), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 26, 2008
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Source: [NPI Profile](https://npiprofile.com/npi/1669629275) · Data from the CMS NPPES public registry.