Constance Janene Jackson, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD18409 Issued in OR

Practice address

4800 SW Macadam Ave
Suite 350
Portland, OR 97239-3925

Phone

(503) 297-6656

Fax

(503) 297-5779

NPI assigned

Oct 12, 2006

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2015 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• NW Psychiatric & Mental Health Services

  • Psychiatry Physician
  • Portland, OR
  • NPI 1851725709
  NPD (past)

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320364800000",
    "number": "1083703391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3439 NE SANDY BLVD",
            "address_2": "PMB 375",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321959",
            "telephone_number": "503-284-8841",
            "fax_number": "503-282-3302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 SW MACADAM AVE",
            "address_2": "SUITE 350",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393925",
            "telephone_number": "503-297-6656",
            "fax_number": "503-297-5779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CONSTANCE",
        "middle_name": "JANENE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2011-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "MD18409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chezaree Jackson
• Christian Jackson
• Christine Jackson
• Christine Wilkes Jackson, PSY.D.
• Christopher Jackson, MD
• Courtney Brooke Jackson, N.D.
• Deforrest Kwesi Jackson, CADC-1
• Dejia Jackson
• Donald Jackson
• Elijah Jackson

• Psychiatry Physician in Portland, OR
• Providers in Portland, OR by specialty
• Psychiatry Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2011; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.