NPIMap

Individual provider Active NPI

David Jackson, M.D.

  • Emergency Medicine Physician
  • Youngstown, OH
National Provider Identifier
1033195607
Registry record updated Jul 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
35059981J Issued in OH
Practice address
1044 Belmont Ave
Youngstown, OH 44504-1006
Phone
(330) 746-7211
Fax
(330) 656-5901
NPI assigned
Dec 15, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 35059981J OH Primary

Addresses

Primary practice location

1044 Belmont Ave
Youngstown, OH 44504-1006

Mailing address

5700 Darrow Rd
Suite 106
Hudson, OH 44236-5021
Phone (330) 656-5911

Other practice location 1

3535 Pentagon Blvd
Beavercreek, OH 45431-1705
Phone (937) 702-4500

Other practice location 2

3535 Southern Blvd
Kettering, OH 45429-1221
Phone (937) 395-8166

Other practice location 3

405 W Grand Ave
Dayton, OH 45405-7538
Phone (937) 723-3211

Other practice location 4

600 W Main St
Troy, OH 45373-2928
Phone (937) 980-7010

Other practice location 5

6147 State Route 122
Middletown, OH 45005-5201
Phone (513) 261-3410

Other practice location 6

1997 Miamisburg Centerville Rd
Centerville, OH 45459-3811
Phone (937) 401-6228

Other practice location 7

8701 Old Troy Pike
Huber Heights, OH 45424-1066
Phone (937) 558-3338

Other practice location 8

450 Washington Jackson Rd Ste F
Eaton, OH 45320-8699
Phone (937) 456-8376

Other practice location 9

1141 N Monroe Dr
Xenia, OH 45385-1619
Phone (937) 352-2500

Other practice location 10

100 Kettering Way
Franklin, OH 45005-1155
Phone (937) 458-4700

Other practice location 11

4000 Miamisburg Centerville Rd
Miamisburg, OH 45342-7615
Phone (937) 384-8791

Other identifiers 4

IdentifierTypeStateIssuer
700007026OtherOHRAILROAD MEDICARE
0805230MedicaidOH
001474708-0001OtherOHPENNSYLVANIA MEDICAID
P00360149OtherOHRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041217000325 OH Practitioner - Emergency Medicine 7618934936 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Oklahoma College of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ohio Valley Physicians IncGroup PAC ID 8729032966, 130 clinicians

Practice addresses (Care Compare)

870 Amherst Rd NE
G100
Massillon, OH 44646-8516
Phone (330) 809-1801

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35059981JOHMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ohio Valley Physicians Inc Emergency Medicine CurrentSince Oct 20, 2025 Accepting new patients
Emergency Medicine Physicians of Lake County LTD Emergency Medicine CurrentSince Dec 28, 2020 Accepting new patients
Emergency Medicine Physicians of Lancaster, LTD. Emergency Medicine CurrentSince Jun 18, 2019 Accepting new patients
Ohio Valley Physicians Inc CurrentSince Oct 20, 2025 Accepting new patients
Mahoning Valley Emergency Specialists LLC Emergency Medicine Past Accepting new patients
Mves Boardman LLC Emergency Medicine Past Accepting new patients
Tayor 2 Elite Services, Inc. Past Accepting new patients
Mves Austintown LLC Emergency Medicine Past Accepting new patients

Locations

936 State Route 160
Gallipolis, OH 45631
Phone (740) 446-4600

401 N Ewing St
Lancaster, OH 43130
Phone (740) 687-8000

870 Amherst Rd NE
#G100
Massillon, OH 44646
Phone (330) 809-1801

36000 Euclid Ave
Willoughby Hills, OH 44094
Phone (440) 375-8166

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564012800000",
    "number": "1033195607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 DARROW RD",
            "address_2": "SUITE 106",
            "city": "HUDSON",
            "state": "OH",
            "postal_code": "442365021",
            "telephone_number": "330-656-5911",
            "fax_number": "330-656-5901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 BELMONT AVE",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445041006",
            "telephone_number": "330-746-7211",
            "fax_number": "330-656-5901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3535 Pentagon Blvd",
            "address_purpose": "LOCATION",
            "city": "Beavercreek",
            "state": "OH",
            "postal_code": "454311705",
            "country_code": "US",
            "telephone_number": "937-702-4500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3535 Southern Blvd",
            "address_purpose": "LOCATION",
            "city": "Kettering",
            "state": "OH",
            "postal_code": "454291221",
            "country_code": "US",
            "telephone_number": "937-395-8166",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "405 W Grand Ave",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454057538",
            "country_code": "US",
            "telephone_number": "937-723-3211",
            "fax_number": "937-723-4609",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 W Main St",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "OH",
            "postal_code": "453732928",
            "country_code": "US",
            "telephone_number": "937-980-7010",
            "fax_number": "937-980-7019",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6147 State Route 122",
            "address_purpose": "LOCATION",
            "city": "Middletown",
            "state": "OH",
            "postal_code": "450055201",
            "country_code": "US",
            "telephone_number": "513-261-3410",
            "fax_number": "513-261-3419",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1997 Miamisburg Centerville Rd",
            "address_purpose": "LOCATION",
            "city": "Centerville",
            "state": "OH",
            "postal_code": "454593811",
            "country_code": "US",
            "telephone_number": "937-401-6228",
            "fax_number": "937-401-6447",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8701 Old Troy Pike",
            "address_purpose": "LOCATION",
            "city": "Huber Heights",
            "state": "OH",
            "postal_code": "454241066",
            "country_code": "US",
            "telephone_number": "937-558-3338",
            "fax_number": "937-558-3349",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "450 Washington Jackson Rd Ste F",
            "address_purpose": "LOCATION",
            "city": "Eaton",
            "state": "OH",
            "postal_code": "453208699",
            "country_code": "US",
            "telephone_number": "937-456-8376",
            "fax_number": "937-456-8377",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1141 N Monroe Dr",
            "address_purpose": "LOCATION",
            "city": "Xenia",
            "state": "OH",
            "postal_code": "453851619",
            "country_code": "US",
            "telephone_number": "937-352-2500",
            "fax_number": "937-352-3501",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Kettering Way",
            "address_purpose": "LOCATION",
            "city": "Franklin",
            "state": "OH",
            "postal_code": "450051155",
            "country_code": "US",
            "telephone_number": "937-458-4700",
            "fax_number": "937-458-4737",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4000 Miamisburg Centerville Rd",
            "address_purpose": "LOCATION",
            "city": "Miamisburg",
            "state": "OH",
            "postal_code": "453427615",
            "country_code": "US",
            "telephone_number": "937-384-8791",
            "fax_number": "937-384-8729",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DAVID",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2019-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35059981J",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "700007026",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0805230",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PENNSYLVANIA MEDICAID",
            "identifier": "001474708-0001",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00360149",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Youngstown, OH

Sources for this page

Verify at the official NPI Registry.