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Anita Dionne Jackson

Physician β€’ Palm Coast, FL

Active NPI 1134699481 Individual Practitioner Female Practitioner
Practice location in NPPES

29 Baltimore Ln
Palm Coast, FL 321378851

Call 3862641398 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

29 Baltimore Ln

Palm Coast, FL 321378851

Telephone 3862641398
Fax 3863035536
Organization at the Same NPPES Address or Phone
Pivotal Health Systems Llc Facility NPI 1538949672

Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.

NPI first issued

2018

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Medicare assignment not listed

CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2022-07-12
Home Health Primary Specialty

NUCC Taxonomy Code: 251E00000X

License # reported to NPPES FL 30212414

A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

In Home Supportive Care

NUCC Taxonomy Code: 253Z00000X

An In Home Supportive Care Agency provides services in the patient's home with the goal of enabling the patient to remain at home. The services provided may include personal care services such as hands-on assistance with activities of daily living (ADLs), e.g., eating, bathing, dressing, and bladder and bowel requirements; homemaker services and instrumental activities of daily living (IADLs), e.g., taking medications, shopping for groceries, laundry, housekeeping, and companionship; and/or supervision or cuing so that a person can perform tasks themselves.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Florida Department of Health Medical Quality Assurance.
Look Up on State Board Site

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

7 Historical Events
πŸ“
Updated Business Mailing Address July 12, 2022

Registered at 17 OLD KINGS RD N STE E, PALM COAST, FL 321378283 (Tel: 3862641398)

βœ…
NPI Profile Active November 29, 2018

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) November 29, 2018

Registered at 29 BALTIMORE LN, PALM COAST, FL 321378851 (Tel: 3862641398)

πŸ“
Business Mailing Address (Initial Record) November 29, 2018

Registered at 29 BALTIMORE LN, PALM COAST, FL 321378851 (Tel: 3862641398)

πŸ‘€
Provider Name / Credentials (Initial Record) November 29, 2018

Recorded as ANITA JACKSON

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) November 29, 2018

In Home Supportive Care

🟒
Initial NPI Registration & Enumeration November 29, 2018

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1134699481
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 29, 2018
Last Update: July 12, 2022
Sole Proprietor: Yes

Mailing Address

17 Old Kings Rd N Ste E

Palm Coast, FL 321378283

Phone: 3862641398

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.