1. Home
  2. Directory
  3. Alabama
  4. Montgomery
  5. Internal Medicine
  6. NPI Profile

JACKSON HOSPITAL AND CLINIC INC
NPI 1912362773
Internal Medicine - Cardiovascular Disease in Montgomery, AL

Active since December 22, 2015
1758 PARK PL, SUITE 401, MONTGOMERY, AL 36106(334) 264-9191(334) 264-9821 Get Directions Write a Review

NPPES record last updated: March 9, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Mar 9, 2026, Dec 22, 2015 (2 updates tracked since 2015).

About Jackson Hospital And Clinic Inc NPPES

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

JACKSON HOSPITAL AND CLINIC INC (NPI 1912362773), doing business as Jackson Clinic Cardiology, is a healthcare organization registered as a cardiovascular disease in Montgomery, Alabama and active in the NPI registry since December 2015. The organization lists Kelin Penney, Administrator, as its authorized official.

NPPES Registry Identity

NPI1912362773
Entity TypeOrganization
Primary Taxonomy207RC0000X
Legal Business NameJACKSON HOSPITAL AND CLINIC INC
Location Address1758 PARK PL, SUITE 401Montgomery, AL 36106-1127
Mailing Address1722 Pine St Ste 804Montgomery, AL 36106-1108 · (334) 240-2337 · Fax (334) 293-6859
Phone(334) 264-9191
Fax(334) 264-9821
Organization SubpartNo
Authorized OfficialKelin PenneyAdministrator · (334) 240-2335
Enumeration DateDecember 22, 2015
Last NPPES UpdateMarch 9, 20262 updates tracked since enumeration
NPPES CertifiedMarch 9, 2026
✔ NPI 1912362773 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Cardiovascular DiseaseAllopathic & Osteopathic Physicians
Taxonomy Code207RC0000X
Definition
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.
1758 PARK PL, Montgomery, AL 36106
Open in Google Maps ↗

Other Names 1

Doing Business AsJackson Clinic Cardiology

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jackson Hospital And Clinic Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

247

Medicare enrollment records show 247 clinicians reassign Medicare billing to Jackson Hospital And Clinic Inc, which bills Medicare for the services they deliver. Of these, 22 practice at this address and 167 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 26

Nurse Practitioner86
Internal Medicine39
Family Practice26
Cardiovascular Disease (Cardiology)10
General Surgery9
Hospitalist8
Otolaryngology8
Urology7
18 other specialties54

Nearest to this location (20)

See all 247
Ravichandra Boyella, M.D
Cardiovascular Disease (Cardiology)
NPI 1104021567
1758 PARK PL STE 401
Montgomery, AL 36106
(334) 264-9191
✔ PECOS✔ Accepts MedicareSame address
Mary Brock, CRNP, FNP-C
Nurse Practitioner
NPI 1467304931
1758 PARK PL STE 401
Montgomery, AL 36106
(334) 264-9191
✔ PECOSSame address
Andrea Steinbrink Virk, CRNP
Nurse Practitioner
NPI 1710470554
1758 PARK PL STE 406
Montgomery, AL 36106
(334) 240-2348
✔ PECOS✔ Accepts MedicareSame address
Maegan Allen, CRNP
Nurse Practitioner
NPI 1598339038
1758 PARK PL STE 201
Montgomery, AL 36106
(334) 263-3630
✔ PECOS✔ Accepts MedicareSame address
Janet Baumann, CRNP
Nurse Practitioner
NPI 1053750315
1758 PARK PL STE 100
Montgomery, AL 36106
(334) 265-8455
✔ PECOS✔ Accepts MedicareSame address
Tressa Bolton, CRNP
Nurse Practitioner
NPI 1306376694
1758 PARK PL STE 300
Montgomery, AL 36106
(334) 293-8922
✔ PECOS✔ Accepts MedicareSame address
Latoya Clark, MD
Obstetrics/Gynecology
NPI 1346566700
1758 PARK PL SUITE 406
Montgomery, AL 36106
(251) 716-4744
✔ PECOS✔ Accepts MedicareSame address
Jennifer Farrior, CRNP
Nurse Practitioner
NPI 1467166975
1758 PARK PL STE 300
Montgomery, AL 36106
(334) 293-8922
✔ PECOS✔ Accepts MedicareSame address
Amy Jones, WHNP-BC
Nurse Practitioner
NPI 1528690542
1758 PARK PLACE SUITE 301
Montgomery, AL 36106
(334) 240-2335
✔ PECOS✔ Accepts MedicareSame address
Oluwagbenga Koriko, CRNP
Nurse Practitioner
NPI 1427875475
1758 PARK PL STE 300
Montgomery, AL 36106
(334) 293-8922
✔ PECOS✔ Accepts MedicareSame address
Justin Parden, M.D.
Vascular Surgery
NPI 1578790895
1758 PARK PL STE 300
Montgomery, AL 36106
(334) 293-8922
✔ PECOS✔ Accepts MedicareSame address
Crystal Reese
Obstetrics/Gynecology
NPI 1780003822
1758 PARK PL STE 301
Montgomery, AL 36106
(334) 284-1500
✔ PECOS✔ Accepts MedicareSame address
Ernestine Takang, CRNP
Nurse Practitioner
NPI 1619554755
1758 PARK PL STE 401
Montgomery, AL 36106
(334) 264-9191
✔ PECOSSame address
William Veale, MD, MPH
Vascular Surgery
NPI 1093992646
1758 PARK PL STE 300
Montgomery, AL 36106
(334) 293-8922
✔ PECOS✔ Accepts MedicareSame address
Raymond Wheat, CRNP
Nurse Practitioner
NPI 1992438071
1758 PARK PL STE 406
Montgomery, AL 36106
(334) 240-2348
✔ PECOS✔ Accepts MedicareSame address
Pamela Beams, DO
Otolaryngology
NPI 1750764221
1111 OLIVE ST
Montgomery, AL 36106
(334) 834-7221
✔ PECOS✔ Accepts MedicareSame address
Andrew Ford, MD
Otolaryngology
NPI 1164411963
1111 OLIVE ST
Montgomery, AL 36106
(334) 834-7221
✔ PECOSSame address
Jade Hoy, D.O.
Family Practice
NPI 1528268703
1111 OLIVE STREET
Montgomery, AL 36106
(334) 293-8888
✔ PECOS✔ Accepts MedicareSame address
Ezmina Lalani, D.O.
Internal Medicine
NPI 1831407964
1111 OLIVE ST
Montgomery, AL 36106
(334) 293-8888
✔ PECOS✔ Accepts MedicareSame address
Blake Raggio, MD
Otolaryngology
NPI 1497174189
1111 OLIVE ST
Montgomery, AL 36106
(334) 834-7221
✔ PECOSSame address
See all 247 clinicians

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

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 Jackson Hospital And Clinic Inc's NPI number?

The NPI number for Jackson Hospital And Clinic Inc is 1912362773. It was assigned to this organization in the NPPES registry on December 22, 2015. The provider is doing business as Jackson Clinic Cardiology.

Where is Jackson Hospital And Clinic Inc located?

Jackson Hospital And Clinic Inc is located at 1758 Park Pl Suite 401, Montgomery, AL 36106. The listed phone number is (334) 264-9191.

What is Jackson Hospital And Clinic Inc's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Cardiovascular Disease, with taxonomy code 207RC0000X.

Is Jackson Hospital And Clinic Inc enrolled in Medicare?

Yes. Jackson Hospital And Clinic Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Jackson Hospital And Clinic Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 247 clinicians in 26 Medicare specialties reassign their Medicare billing to Jackson Hospital And Clinic Inc. A 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 the clinician's services. The largest specialties are Nurse Practitioner (86), Internal Medicine (39) and Family Practice (26). Of these, 22 practice at this address and 167 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Jackson Hospital And Clinic Inc was last updated on March 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.