Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1558909473 Individual Practitioner Female Practitioner

Elissa Jackson , LPN

Licensed Practical Nurse • Mentor, OH

Professional Overview & Biography Verified Profile Summary

Elissa Jackson, LPN is a registered healthcare professional specializing in Licensed Practical Nurse in Mentor, OH. Practice services are available at 7232 JUSTIN WAY under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

7232 Justin Way

Mentor, OH 440604881

Telephone 4405788200
Associated Practice Facility / Clinic
🏢 Signature Health Inc. Facility NPI 1184170136

Specialty Benchmarks & Practice Insights

Comparative analytics for Licensed Practical Nurse in Mentor, OH

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 14.0 Yrs
Regional Practice Density
56 Specialists

Practicing in Mentor, OH (13034 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2022-09-16
Licensed Practical Nurse Primary Specialty

NUCC Taxonomy Code: 164W00000X

State License OH LPN.148984.MEDS-IV

An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

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.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
0430027 (OH)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Dr. Tiffany Jones , MD

Psychiatry & Neurology - Psychiatry

NPI 1003082413

Doctor of Medicine (M.D.)

Ashley Focht

Counselor

NPI 1003329079
Fatimaah Fullilove , LSW, LICDC

Social Worker - Clinical

NPI 1003329228

Licensed Social Worker, LICDC

NPI 1003420076

Licensed Professional Clinical Counselor

NPI 1003420738
Clotilda Raymond

Social Worker

NPI 1003436825

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events
🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 16, 2022

Case Manager/Care Coordinator

📍
Updated Practice Location January 28, 2021

Registered at 7232 JUSTIN WAY, MENTOR, OH 440604881 (Tel: 4405788200)

📍
Updated Business Mailing Address January 28, 2021

Registered at 7232 JUSTIN WAY, MENTOR, OH 440604881 (Tel: 4405788200)

👤
Provider Name / Credentials Updated January 28, 2021

Recorded as ELISSA JACKSON, LPN

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) January 28, 2021

Licensed Practical Nurse (License #LPN.148984.MEDS-IV in OH)

NPI Profile Active December 11, 2019

NPI status registered as active in NPPES database

📍
Updated Practice Location December 11, 2019

Registered at 3100 E 45TH ST STE 314, CLEVELAND, OH 441271095 (Tel: 2164419622)

📍
Updated Business Mailing Address December 11, 2019

Registered at 3100 E 45TH ST STE 314, CLEVELAND, OH 441271095 (Tel: 2164419622)

👤
Provider Name / Credentials Updated December 11, 2019

Recorded as ELISSA JACKSON

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) December 11, 2019

Case Manager/Care Coordinator

🟢
Initial NPI Registration & Enumeration December 11, 2019

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1558909473
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: December 11, 2019
Last Update: September 16, 2022
Sole Proprietor: No

Mailing Address

7232 Justin Way

Mentor, OH 440604881

Phone: 4405788200

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.