Phyllis E Jackson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA000510L Issued in PA

Practice address

300 Evergreen Dr
Suite 150
Glen Mills, PA 19342-1059

Phone

(610) 874-1184

Fax

(610) 874-4258

NPI assigned

Nov 5, 2013

Last updated

May 6, 2014By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

CMC Department of Medicine Group PAGroup PAC ID 2163335878, 474 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Inspira Medical Center Mullica Hill Hospital, Elmer, NJ, CCN 310069

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pjackson166879@direct.cooperhealth.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• CMC Department of Medicine Group PA

  • Cardiovascular Disease Physician
  • Camden, NJ
  • NPI 1609908094
  Medicare reassignment Care Compare group
• CMC Department of Medicine Group PA

  • Specialist
  • Camden, NJ
  • NPI 1386682094
  NPD
• CMC Department of Medicine Group PA

  • Neurology Physician
  • Sewell, NJ
  • NPI 1437281771
  NPD
• Health Access Network

  • Physical Medicine & Rehabilitation Physician
  • Chester, PA
  • NPI 1356460380
  NPD (past)
• Prospect Health Access Network, Inc.

  • Gynecologic Oncology Physician
  • Chester, PA
  • NPI 1134574775
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Inspira Medical Centers, Inc.

  dba Inspira Medical Center Elmer

  • General Acute Care Hospital
  • Elmer, NJ
  • NPI 1255396024
  Care Compare affiliation
• Inspira Medical Centers, Inc.

  dba Inspira Medical Center Mullica Hill

  • General Acute Care Hospital
  • Mullica Hill, NJ
  • NPI 1366097032
  Care Compare affiliation
• South Jersey Hospital, Inc.

  dba SJH Sports Rehab Care - Tomlin Station

  • Physical Therapy Clinic/Center
  • Mullica Hill, NJ
  • NPI 1609158732

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1383609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399334400000",
    "number": "1043649627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 EVERGREEN DR",
            "address_2": "SUITE 150",
            "city": "GLEN MILLS",
            "state": "PA",
            "postal_code": "193421059",
            "telephone_number": "610-874-1184",
            "fax_number": "610-874-4258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 EVERGREEN DR",
            "address_2": "SUITE 150",
            "city": "GLEN MILLS",
            "state": "PA",
            "postal_code": "193421059",
            "telephone_number": "610-874-1184",
            "fax_number": "610-874-4258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PHYLLIS",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-05",
        "last_updated": "2014-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA000510L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madeleine Elizabeth Hunt, OTR/L
• Donna V. Huntington, LCSW
• Abby Catherine Ingenito, CRNP
• Megan Ingley, MD
• Aradhana S. Ishwar, D.O.
• Barry J Jacobson, MD
• Christine Marie Jakob
• Pooja Bharat Jasani, D.O.
• Laura Beth Jewell, LPC
• Angela Gaudiuso Johnson, OTR/L

• Physician Assistant in Glen Mills, PA
• Providers in Glen Mills, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2014; 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.

Verify at the official NPI Registry.