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Deactivated NPI 1154423234 Deactivated / Inactive NPI Male Practitioner

Dr. Jerry S Jackson , DPM

Podiatrist • Montezuma, KS

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Jerry Jackson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date September 01, 2006
NPI Deactivation Date March 01, 2022
Total Practice Duration ~16 Years of Practice (2006 – 2022)

Professional Overview & Biography Verified Profile Summary

Dr. Jerry Jackson, DPM was a registered Podiatrist practicing in Montezuma, KS. Throughout an active medical career spanning 16 years, Dr. Jackson provided care at the practice location at 300 AZTEC ST until profile deactivation on 2022-03-01.

Historical Medicare Part B clinical services included removal of fingernails or toenails, removal of single thickened skin growth, removal of noncancer thickened skin growth, 2-4 growths. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

300 Aztec St

Montezuma, KS 67867

Telephone 8552599183
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Podiatrist in Montezuma, KS

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 29.5 Yrs
Regional Practice Density
1 Specialists

Practicing in Montezuma, KS (64 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
7.8% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2020)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
11721 Removal of fingernails or toenails, 6 or more nails
442 441 $47.32 $43.64

Medical Specialties & State Licenses

Podiatrist Primary Specialty

NUCC Taxonomy Code: 213E00000X

State License KS 145

A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.

Practice Associates & Co-Workers

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

7 Associated Practitioners
Abigail Cook

Nurse Practitioner

NPI 1265268767
Crystal Sahner

Psychologist - Clinical

NPI 1457721631
NPI 1487427316

Doctor of Optometry

NPI 1699975904

Doctor of Dental Surgery, Master of Science

Christy Parson , FNP-C

Nurse Practitioner - Family

NPI 1770298580

Family Nurse Practitioner (Certified)

Tenia Bragg , PMHNP-BC

Nurse Practitioner - Psychiatric/Mental Health

NPI 1922865625

Psychiatric-Mental Health Nurse Practitioner (Board Certified)

Career & Practice History Timeline

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

7 Historical Events
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NPI Profile Deactivated March 01, 2022

Record deactivated on March 01, 2022

NPI Profile Active December 12, 2016

NPI status registered as active in NPPES database

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Updated Practice Location December 12, 2016

Registered at 300 AZTEC ST, MONTEZUMA, KS 67867 (Tel: 8552599183)

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Updated Business Mailing Address December 12, 2016

Registered at 12910 SHELBYVILLE RD, SUITE 300, LOUISVILLE, KY 402431593 (Tel: 5022442441)

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Provider Name / Credentials Updated December 12, 2016

Recorded as JERRY JACKSON, DPM

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Medical Taxonomy / Specialty Registered (Primary Specialty) December 12, 2016

Podiatrist (License #145 in KS)

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Initial NPI Registration & Enumeration September 01, 2006

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: 1154423234
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 01, 2006
Last Update: December 12, 2016
Deactivation Date: March 01, 2022

Mailing Address

12910 Shelbyville Rd, Suite 300

Louisville, KY 402431593

Phone: 5022442441

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.