Talicia Jackson, MD
Individual provider Active NPI Obstetrics & Gynecology Physician · Newark, NJ
NPI 1053932178 · NPPES record last updated Sep 30, 2024
Key facts
- NPI
- 1053932178
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 5MA12190200 (NJ)
- Practice address
- 140 Bergen St # C
Newark, NJ 07103-2425 - Phone
- (973) 972-2700
- NPI assigned
- Apr 29, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 17
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- University Physician Associates of New Jersey Inc
Practice addresses (Care Compare)
140 Bergen St
Newark, NJ 07103-2425
Phone (973) 972-9000
Hospital & facility affiliations
- The University Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240925001133 | NJ | Practitioner - Obstetrics/Gynecology | 1052852480 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5MA12190200 | NJ | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Physician Associates of New Jersey Inc | Obstetrics & Gynecology | Current |
Accepting new patients |
| University Physician Associates of New Jersey Inc | Current |
Accepting new patients | |
| University Hospital | Past | Accepting new patients | |
| University Physician Associates of New Jersey Inc | Past | Accepting new patients |
Locations
150 Bergen St
Newark, NJ 07103
Phone (973) 972-6056
140 Bergen St
#C
Newark, NJ 07103
Phone (973) 972-2700
140 Bergen St
Newark, NJ 07103
Phone (973) 972-0320
30 Bergen St
#12
Newark, NJ 07107
Phone (973) 972-0037
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 5MA12190200 | NJ | Yes |
Addresses
Primary practice location
140 Bergen St # C
Newark, NJ 07103-2425
Mailing address
140 Bergen St # C
Newark, NJ 07103-2425
Phone (973) 322-5281
Other providers in Newark, NJ
- Cordero Jackson
- Douglas T Jackson
- Eric Robert Jackson Jr.
- John H Jackson Jr.
- Shadane Jackson
- Terri Jackson
- Christine Ann Jacob
- Denise Jacob
- Jeena Jacob
- Jerril Jacob
All providers in Newark, NJ · Obstetrics & Gynecology Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.