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Johnny Jackson

Peer Specialist β€’ Fairfield, OH

Active NPI 1336929884 Individual Practitioner Male Practitioner
Practice location in NPPES

6570 Sosna Dr
Fairfield, OH 450142222

Call 5139424673 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

6570 Sosna Dr

Fairfield, OH 450142222

Telephone 5139424673
Fax 5138601439
Organization at the Same NPPES Address or Phone
Decoach Team Llc Facility NPI 1366992224

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

NPI first issued

2023

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

Compared with the same specialty in Fairfield and Ohio

4 active clinicians are listed under Peer Specialist with a practice address in Fairfield, OH (3,082 in Ohio).

Addresses are self-reported to NPPES and may be out of date.

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: 2023-11-16
Peer Specialist Primary Specialty

NUCC Taxonomy Code: 175T00000X

License # reported to NPPES OH APS.004453

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

Case Manager/Care Coordinator

NUCC Taxonomy Code: 171M00000X

A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee's progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management.

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: State Medical Board of Ohio.
Look Up on State Board Site

Clinicians Sharing This Practice Address or Phone

Clinicians sharing this NPPES address, phone or fax; a shared contact does not mean they work together.

2 listed
Dr. Rick Hum , MD

Internal Medicine

NPI 1063780799

Doctor of Medicine (M.D.)

Lejeana Miller , RN

Nurse Practitioner - Psychiatric/Mental Health

NPI 1821650193

Registered Nurse

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 October 30, 2023

Registered at 100 CROWNE POINT PL, CINCINNATI, OH 452415427 (Tel: 5137437628)

βœ…
NPI Profile Active October 03, 2023

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) October 03, 2023

Registered at 6570 SOSNA DR, FAIRFIELD, OH 450142222 (Tel: 5139424673)

πŸ“
Business Mailing Address (Initial Record) October 03, 2023

Registered at 3103 DIXIE HWY, HAMILTON, OH 450151653 (Tel: 5138924673)

πŸ‘€
Provider Name / Credentials (Initial Record) October 03, 2023

Recorded as JOHNNY JACKSON

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) October 03, 2023

Peer Specialist (license number reported to NPPES: OH APS.004453)

🟒
Initial NPI Registration & Enumeration October 03, 2023

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1336929884
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: October 03, 2023
Last Update: November 16, 2023
Sole Proprietor: Yes

Mailing Address

100 Crowne Point Pl

Cincinnati, OH 452415427

Phone: 5137437628

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.