Glenna S Jackson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35060413 Issued in OH

Practice address

3780 Medina Rd
Ste. 310
Medina, OH 44256-9311

Phone

(330) 725-8441

Fax

(330) 725-8442

NPI assigned

Jan 30, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Summa Physicians LLC

  • Obstetrics & Gynecology Physician
  • Akron, OH
  • NPI 1235167719
  NPD
• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313366400000",
    "number": "1003887779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3780 MEDINA RD",
            "address_2": "STE. 310",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442569311",
            "telephone_number": "330-725-8441",
            "fax_number": "330-725-8442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3780 MEDINA RD",
            "address_2": "STE. 310",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442569311",
            "telephone_number": "330-725-8441",
            "fax_number": "330-725-8442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "GLENNA",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-30",
        "last_updated": "2011-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35060413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "825601",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080119109",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Integrative Counseling Services
• Integrity Counseling LLC
• Intervention for Peace Inc.
• Helen F Jablonowski, RN
• Laura Rae Jackam, P.A.
• Krista Jackson, LPN
• Qiana Caprice Jackson
• Raytionna Danielle Jackson
• Sarah Murtha Jackson
• Jacqueline Marie Jacob

• Family Medicine Physician in Medina, OH
• Providers in Medina, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.