Ollie Joseph Jackson III, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

A103543 Issued in CA

Practice address

9001 Wilshire Blvd
Suite #106
Beverly Hills, CA 90211-1838

Phone

(310) 273-8885

Fax

(310) 273-8662

NPI assigned

May 30, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Jay Jackson Other name

Medicare fee-for-service enrollment

Enrolled in CA

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

General Surgery

Education

University of Oklahoma College of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wound Docs ApcGroup PAC ID 2860928629, 23 clinicians

Izuchukwu Okpara MD IncGroup PAC ID 1052698966, 45 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Izuchukwu Okpara MD Inc

  • Surgery Physician
  • Valencia, CA
  • NPI 1679004592

  CA, Single Specialty

  Medicare reassignment Care Compare group NPD
• Wound Docs Apc

  • Surgery Physician
  • Aliso Viejo, CA
  • NPI 1629891676

  CA, Single Specialty

  Medicare reassignment Care Compare group NPD
• Crescent Wound Care Inc

  • Internal Medicine Physician
  • Modesto, CA
  • NPI 1841920501

  CA, Single Specialty

  Medicare reassignment NPD
• Panacea Pointe Medical Centre

  • Medical Specialty Clinic/Center
  • Woodland Hills, CA
  • NPI 1164370573
  NPD Authorized official
• Crescent Wound Care Inc

  • Family Medicine Physician
  • The Dalles, OR
  • NPI 1942177548

  Single Specialty

  NPD
• California Wound Health PC

  • General Practice Physician
  • Los Angeles, CA
  • NPI 1609129311

  Single Specialty

  NPD (past)
• Crescent Wound Care Inc

  • Obstetrics & Gynecology Physician
  • Spencer, TN
  • NPI 1538957436

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1212105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678838400000",
    "number": "1104084698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9001 WILSHIRE BLVD",
            "address_2": "SUITE #106",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902111838",
            "telephone_number": "310-273-8885",
            "fax_number": "310-273-8662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9001 WILSHIRE BLVD",
            "address_2": "SUITE #106",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902111838",
            "telephone_number": "310-273-8885",
            "fax_number": "310-273-8662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "OLLIE",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-30",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "CA",
            "license": "A103543",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "A103543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAY",
            "last_name": "JACKSON",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Brian Paul Jacks, MD
• Jackson K Lau OD Inc
• Ashton Raiden Jackson, MD
• Greg Jackson, PPS
• Kirsten L Jackson
• Jacob E Tauber MD a Professional
• Jacob E. Tauber, MD, a Professional Corporation
• Jacob F Esagoff DDS Inc
• Jacob Moussai MD Inc
• Jacobs & Liang Dental Group

• All providers in Beverly Hills, CA
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2023; 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.