SUSAN MARIE JACKSON CNP
NPI 1689914087
Nurse Practitioner - Adult Health in Cincinnati, OH

Q: What is Susan Jackson's NPI number?

The NPI number for Susan Jackson is 1689914087. It was assigned to this individual provider in the NPPES registry on February 21, 2013.

Q: What is Susan Jackson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

Q: When was this NPI record last updated?

The NPPES record for Susan Jackson was last updated on May 17, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.

Active since February 21, 2013PECOS Enrolled

4805 MONTGOMERY RD STE 410, CINCINNATI, OH 45212(513) 559-1222(513) 559-1235 Get Directions Write a Review

NPPES record last updated: May 17, 2018. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: May 17, 2018, May 2, 2018 (2 updates tracked since 2018).

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About Susan Marie Jackson Cnp NPPES

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

SUSAN MARIE JACKSON CNP (NPI 1689914087) is an individual adult health provider in Cincinnati, Ohio, licensed in Ohio (CNP.13953) and active in the NPI registry since February 2013. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1689914087

Entity TypeIndividualFemale

Primary Taxonomy363LA2200X

Provider Legal NameSUSAN MARIE JACKSONCredential: CNP

Location Address4805 MONTGOMERY RD STE 410Cincinnati, OH 45212

Mailing Address4805 Montgomery Rd Ste 150Cincinnati, OH 45212-2280 · (513) 961-5558 · Fax (513) 961-1912

Phone(513) 559-1222

Fax(513) 559-1235

Sole ProprietorNo

Enumeration DateFebruary 21, 2013

Last NPPES UpdateMay 17, 20182 updates tracked since enumeration

✔ NPI 1689914087 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LA2200X

Licenses✔ Licensed in OH · CNP.13953✔ Licensed in KY · 1135253

Also ListedRegistered NurseTaxonomy 163W00000X · License RN.259883-COA1 (OH)

4805 MONTGOMERY RD STE 410, Cincinnati, OH 45212

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Susan Marie Jackson Cnp 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 45212 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

$84.72 typical visit price

range $54.34 – $166.65

Typical copayment $21.18 (range $13.58 – $41.66)

Most-billed visit code 99203

Established Patient

$96.44 typical visit price

range $17.10 – $135.40

Typical copayment $24.11 (range $4.27 – $33.85)

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 13

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

BABER KHAN MD

Psychiatry & Neurology (Neurology)