Paul Jackson, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5101012453 Issued in MI

Practice address

17800 Newburgh Rd
Suite 103
Livonia, MI 48152-2700

Phone

(734) 464-9540

Fax

(734) 464-0438

NPI assigned

Jan 20, 2006

Sex

Male

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 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Family PracticeAlso: General Practice

Education

Michigan State University College of Osteopathic Medicine, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

VMD Primary Providers Eastern Michigan PCGroup PAC ID 9234480575, 63 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tone Home Health Services Home health agency, Farmington Hills, MI, CCN 237634

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: paul.jackson.1@21803.direct.athenahealth.com
• Direct secure messaging: pjackson19788@direct.hfhs.org

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.

• VMD Primary Providers Eastern Michigan, PC

  • Family Medicine Physician
  • Novi, MI
  • NPI 1336625540
  Medicare reassignment Care Compare group NPD
• Envision Medical Group PLLC

  • Family Medicine Physician
  • Northville, MI
  • NPI 1578891750
  NPD
• Envision Medical Group PLLC

  • Family Medicine Physician
  • Northville, MI
  • NPI 1821391848
  NPD
• Envision Diagnostic Center PLLC

  • Diagnostic Radiology Physician
  • Novi, MI
  • NPI 1144543562

  Family Medicine

  NPD (past)
• Inpatient Consultants of Michigan PC

  • Hospitalist Physician
  • Livonia, MI
  • NPI 1861442824
  NPD (past)
• Livonia Family Physicians, PC

  • Family Medicine Physician
  • Brighton, MI
  • NPI 1063677912
  NPD (past)
• Livonia Family Physicians, PC

  • Family Medicine Physician
  • Livonia, MI
  • NPI 1679544506
  NPD (past)

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

• T.O.N.E. Home Health Services, Inc.

  • Home Health Agency
  • Farmington Hills, MI
  • NPI 1861420879
  Care Compare affiliation

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

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616630400000",
    "number": "1053391342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17800 NEWBURGH RD",
            "address_2": "SUITE 103",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481522700",
            "telephone_number": "734-464-9540",
            "fax_number": "734-464-0438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17800 NEWBURGH RD",
            "address_2": "SUITE 103",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481522700",
            "telephone_number": "734-464-9540",
            "fax_number": "734-464-0438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PAUL",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-20",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101012453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3414244",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deana Jackson
• Heather Jackson
• Kassandra Lynn Jackson, LMSW
• Mykerra Brieanna Jackson I
• Nicole Vanessa Jackson, LMSW
• Shantele Dennene Jackson
• Stephanie Jackson, LBSW, QMHP, QIDP
• Tayonna Jackson
• Zannie Roy Jackson Jr., PEER SUPPORT SPECIAL
• Jaclyn Grad OT LLC (Grow With Me OT)

• Family Medicine Physician in Livonia, MI
• Providers in Livonia, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2021; 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.