Active NPI
Laeia B Jackson, MD
- Radiological Physics Physician
- Toledo, OH
National Provider Identifier
1003348673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiological Physics Physician
- License
- 4301507021
- Practice address
- 5757 Park Center CT.
Toledo, OH 43615 - Phone
- (419) 474-4064
- Fax
- (419) 472-2772
- NPI assigned
- Apr 1, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Radiological Physics Physician | 2085R0205X | 4301507021 | MI | Primary |
Addresses
Primary practice location
5757 Park Center CT.
Toledo, OH 43615
Mailing address
5757 Park Center CT.
Toledo, OH 43615
Phone (419) 474-4064
Other practice location 1
550 S Jackson St
ACB 3rd floor
Louisville, KY 40202-1622
Phone (502) 852-5666
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI, OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Diagnostic Radiology
- Education
- Meharry Medical College School of Medicine, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
26800 Woodmont Dr
Apt 72
Perrysburg, OH 43551-7282
Phone (317) 614-9881
274 E Chicago St
Coldwater, MI 49036-2041
Phone (517) 279-5400
5301 McAuley Dr
Ypsilanti, MI 48197-1051
Phone (734) 712-3456
5640 N Adrian Hwy
Adrian, MI 49221-8318
Phone (517) 577-0000
718 N Macomb St
Monroe, MI 48162-7815
Phone (419) 474-4064
Hospital & facility affiliations
- Promedica Toledo Hospital
- Promedica Monroe Regional Hospital
- Promedica Charles and Virginia Hickman Hospital
- Bay Park Community Hospital
- Memorial Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.17 of 100
- Quality
- 90
- Improvement activities
- 40
- Cost
- 75.56
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Toledo Physicians LLC | Past | Accepting new patients |
Interoperability endpoints
- ljackson782187@direct.hfhs.org
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Internal Medicine Physician
- Toledo, OH
- NPI 1942296033
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Oregon, OH
- NPI 1598765539
-
- General Acute Care Hospital
- Fremont, OH
- NPI 1851338149
-
- General Acute Care Hospital
- Toledo, OH
- NPI 1407854771
-
- General Acute Care Hospital
- Adrian, MI
- NPI 1972564730
-
- General Acute Care Hospital
- Monroe, MI
- NPI 1811097223
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691452800000",
"number": "1003348673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5757 PARK CENTER CT.",
"city": "TOLEDO",
"state": "OH",
"postal_code": "43615",
"telephone_number": "419-474-4064",
"fax_number": "419-472-2772"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5757 PARK CENTER CT.",
"city": "TOLEDO",
"state": "OH",
"postal_code": "43615",
"telephone_number": "419-474-4064",
"fax_number": "419-472-2772"
}
],
"practiceLocations": [
{
"address_1": "550 S Jackson St",
"address_2": "ACB 3rd floor",
"address_purpose": "LOCATION",
"city": "Louisville",
"state": "KY",
"postal_code": "402021622",
"country_code": "US",
"telephone_number": "502-852-5666",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "LAEIA",
"middle_name": "B",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-01",
"last_updated": "2023-08-08",
"certification_date": "2023-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2085R0205X",
"taxonomy_group": "",
"desc": "Radiology, Radiological Physics",
"state": "MI",
"license": "4301507021",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Toledo, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.