Michael B. Jackson, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

234087 Issued in NY

Practice address

80 River St
3D
Hoboken, NJ 07030-5626

Phone

(201) 244-7799

NPI assigned

Oct 5, 2006

Last updated

Sep 10, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Psychiatry

Education

Rutgers R W Johnson Medical School (Cam/New Bruns/Pisc), 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Highland Medical P.C.Group PAC ID 2668370420, 19 clinicians

Montefiore Nyack HospitalGroup PAC ID 2668485046, 21 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Nyack Hospital Hospital, Nyack, NY, CCN 330104

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Highland Medical P.C.

  • General Practice Physician
  • Nyack, NY
  • NPI 1376600304
  Medicare reassignment Care Compare group NPD
• Montefiore Nyack Hospital

  • Neurology Physician
  • Nyack, NY
  • NPI 1073881835
  Medicare reassignment Care Compare group NPD
• Montefiore Nyack Hospital

  • General Acute Care Hospital
  • Nyack, NY
  • NPI 1104808062
  NPD
• Liberty Behavioral Health Associates

  • Psychiatry Physician
  • Jersey City, NJ
  • NPI 1811076607
  NPD (past)
• St Vincents Hospital and Medical Center

  • Specialist
  • New York, NY
  • NPI 1285746354
  NPD (past)

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

• Montefiore Nyack Hospital

  • General Acute Care Hospital
  • Nyack, NY
  • NPI 1104808062
  Care Compare affiliation

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568073600000",
    "number": "1073600896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 CHURCHILL RD",
            "city": "TENAFLY",
            "state": "NJ",
            "postal_code": "076703120",
            "telephone_number": "201-588-9475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 RIVER ST",
            "address_2": "3D",
            "city": "HOBOKEN",
            "state": "NJ",
            "postal_code": "070305626",
            "telephone_number": "201-244-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MICHAEL",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2019-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084F0202X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Forensic Psychiatry",
            "state": "NJ",
            "license": "25MA08023100",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MA08023100",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "234087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ivyrehab Network Inc
• Ivyrehab Network Inc.
• Ivyrehab Network, Inc.
• Shilpa Jackman
• Darsel Ann Jackson, DC
• Stephanie Jacob
• Gianna Lisa Jacobelli
• Abbie Jacobs, MD
• Jagadish V. Damle MD, PA
• Shalaka Jamenis

• Psychiatry Physician in Hoboken, NJ
• Providers in Hoboken, NJ by specialty
• Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; 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.