Brooke A Jackson, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2013-00616 Issued in NC

Practice address

245 E NC Highway 54
Suite 202
Durham, NC 27713-2551

Phone

(919) 294-9440

Fax

(919) 237-3899

NPI assigned

Nov 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Dermatology

Education

Georgetown University School of Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

East Carolina UniversityGroup PAC ID 0244143246, 499 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ecu Health Medical Center Hospital, Greenville, NC, CCN 340040

Merit-based Incentive Payment System (MIPS)

Final score

96.95 of 100Reported as apm

Quality

82.44

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/13216/brand/1/csg/1/fhir/r4
• Direct secure messaging: brooke.jackson.1@13216.direct.athenahealth.com

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.

• East Carolina University

  • Family Medicine Physician
  • Greenville, NC
  • NPI 1972551919
  Medicare reassignment Care Compare group NPD
• Skin Wellness Dermatology Associates, PA

  • Dermatology Physician
  • Durham, NC
  • NPI 1467832881
  Medicare reassignment NPD Authorized official
• East Carolina University

  • Internal Medicine Physician
  • Greenville, NC
  • NPI 1043260474

  Dermatology

  NPD
• East Carolina University

  • Obstetrics & Gynecology Physician
  • Greenville, NC
  • NPI 1528016938
  NPD (past)

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

• Pitt County Memorial Hospital Inc

  • General Acute Care Hospital
  • Washington, NC
  • NPI 1780359687
  Care Compare affiliation
• Pitt County Memorial Hospital, Inc

  • General Acute Care Hospital
  • Greenville, NC
  • NPI 1043218944
  Care Compare affiliation

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628640000000",
    "number": "1093887960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 EAST NC HIGHWAY 54",
            "address_2": "SUITE 202",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "27713",
            "telephone_number": "919-294-9440",
            "fax_number": "919-237-3899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 E NC HIGHWAY 54",
            "address_2": "SUITE 202",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277132551",
            "telephone_number": "919-294-9440",
            "fax_number": "919-237-3899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BROOKE",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2021-08-11",
        "certification_date": "2021-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036093014",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NC",
            "license": "2013-00616",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01633086",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jackson Odondi
• Akua Jackson, PHD
• Alexandra Megan Jackson, CPNP
• Ashton Jackson, RDN
• Bethena M Jackson, CSAC, LCAS-A
• Carrie Ann Jackson, M.ED
• Christy Jackson, RD, LDN
• Delqwan Rashawn Jackson, MSW, LCSWA
• Diamond Mone Jackson, PT, DPT
• George William Jackson, MD

• Dermatology Physician in Durham, NC
• Providers in Durham, NC by specialty
• Dermatology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 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.