Nicole Jackowski, is a medicare enrolled "Nurse Practitioner" physician in Bentleyville, Pennsylvania. Her current practice location is
100 Wilson Road, Bentleyville, Pennsylvania. You can reach out to her office (for appointments etc.) via phone at
(724) 239-2390.
Nicole Jackowski is licensed to practice in Pennsylvania (license number SP018536) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1528576618.
Physician's Profile
| Full Name | Nicole Jackowski |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Location | 100 Wilson Road, Bentleyville, Pennsylvania |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1528576618
- Provider Enumeration Date: 01/11/2018
- Last Update Date: 03/21/2019
Medicare PECOS Information:
- PECOS PAC ID: 5890058853
- Enrollment ID: I20180405000134
Medical Identifiers
Medical identifiers for Nicole Jackowski such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1528576618 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 208D00000X | General Practice | SP018536 (Pennsylvania) | Secondary |
| 363LP2300X | Nurse Practitioner - Primary Care | SP018536 (Pennsylvania) | Secondary |
| 363LS0200X | Nurse Practitioner - School | SP018536 (Pennsylvania) | Secondary |
| 363LW0102X | Nurse Practitioner - Women's Health | SP018536 (Pennsylvania) | Secondary |
| 363L00000X | Nurse Practitioner | SP018536 (Pennsylvania) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Nicole Jackowski allows following entities to bill medicare on her behalf.
| Entity Name | Centerville Clinics Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1801877048
PECOS PAC ID: 7214837202
Enrollment ID: O20040427000681 |
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| Entity Name | A M Rafi Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1255660031
PECOS PAC ID: 9133255698
Enrollment ID: O20100413000098 |
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| Entity Name | Carelon Medical Partners, Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1124443403
PECOS PAC ID: 9931332111
Enrollment ID: O20150424000053 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Nicole Jackowski is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Nicole Jackowski,
1070 Old National Pike Road,
Fredericktown, PA 15333-2114
Ph: (724) 632-6801 | Nicole Jackowski,
100 Wilson Road,
Bentleyville, PA 15314-1028
Ph: (724) 239-2390 |
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