Active NPI
Heather Maria Jackson, D.O.
- Family Medicine Physician
- Beavercreek, OH
National Provider Identifier
1104034008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 34010401
- Practice address
- 2322 Lakeview Dr
Beavercreek, OH 45431-2772 - Phone
- (937) 426-0106
- Fax
- (937) 426-7153
- NPI assigned
- May 21, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 34010401 | OH | Primary |
Addresses
Primary practice location
2322 Lakeview Dr
Beavercreek, OH 45431-2772
Mailing address
4700 Smith Rd
Ste a
Cincinnati, OH 45212-2787
Phone (513) 533-1199
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL, CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Ohio University, College of Osteopathic Medicine, 2003
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
303 Midnight Shadow
Stephenville, TX 76401-1840
6612 Owens Dr
Pleasanton, CA 94588-3334
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34010401 | OH | MD | Family Medicine Physician |
Interoperability endpoints
- heather.jackson.1@28386.direct.athenahealth.com
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Pleasanton, CA
- NPI 1639710643
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391644800000",
"number": "1104034008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4700 SMITH RD",
"address_2": "STE A",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452122787",
"telephone_number": "513-533-1199",
"fax_number": "513-533-6000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2322 LAKEVIEW DR",
"city": "BEAVERCREEK",
"state": "OH",
"postal_code": "454312772",
"telephone_number": "937-426-0106",
"fax_number": "937-426-7153"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "HEATHER",
"middle_name": "MARIA",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-21",
"last_updated": "2014-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OH",
"license": "34010401",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beavercreek, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2014; 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.