NPIMap

Individual provider Active NPI

Colin Benjamin Jackson

  • Obstetrics & Gynecology Physician
  • Boston, MA
National Provider Identifier
1104243278
Registry record updated Dec 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
274359 Issued in MA
Practice address
85 E Concord St
6TH Floor
Boston, MA 02118-2335
Phone
(617) 414-5166
Fax
(617) 414-7300
NPI assigned
Mar 26, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 9, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Obstetrics & Gynecology Physician 207V00000X 274359 MA Primary

Addresses

Primary practice location

85 E Concord St
6TH Floor
Boston, MA 02118-2335

Mailing address

85 E Concord St
6TH Floor
Boston, MA 02118-2335
Phone (617) 414-5166

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180523001089 MA Practitioner - Obstetrics/Gynecology 1850510488 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Tufts University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
LGH Medical Group, Inc.Group PAC ID 3173626751, 165 clinicians

Practice addresses (Care Compare)

295 Varnum Ave
Lowell, MA 01854-2134
Phone (978) 788-7344

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc CurrentSince Apr 10, 2018 Accepting new patients
LGH Medical Group, Inc. CurrentSince Dec 15, 2023 Accepting new patients
Circle Health OBGYN, LLC. Obstetrics & Gynecology CurrentSince Dec 15, 2023 Accepting new patients
Umass Memorial Medical Group Inc Obstetrics & Gynecology CurrentSince Jan 1, 2022 Accepting new patients
Obhg Massachusetts - Direct, P.C. CurrentSince Mar 1, 2023 Accepting new patients
Pratt OB/GYN Associates, Inc Obstetrics & Gynecology CurrentSince Dec 15, 2023 Accepting new patients
Beth Israel Deaconess Medical Center, Inc. CurrentSince Apr 10, 2018 Accepting new patients
Harvard Medical Faculty Phys at Beth Israel Deaconess Med Ctr Inc Obstetrics & Gynecology CurrentSince Apr 10, 2018 Accepting new patients
Beth Israel Deaconess Medical Center, Inc. CurrentSince Apr 10, 2018 Accepting new patients
Umass Memorial Medical Group, Inc. CurrentSince Jan 1, 2022 Accepting new patients
The Lowell General Hospital Past Accepting new patients
Boston University Obstetrics and Gynecology Foundation, Inc. Obstetrics & Gynecology Past Accepting new patients
LGH Professional Services LLC Past Accepting new patients
Obhg Massachusetts PC Obstetrics & Gynecology Past Accepting new patients
LGH Womanhealth Obstetrics & Gynecology Past Accepting new patients

Locations

330 Brookline Ave
Boston, MA 02215
Phone (617) 667-2000

800 Washington St
Boston, MA 02111
Phone (617) 636-4800

680 Centre St
Brockton, MA 02302
Phone (508) 941-7400

115 Lincoln St
Framingham, MA 01702
Phone (508) 383-1000

100 Hospital Rd
Leominster, MA 01453
Phone (978) 466-4220

295 Varnum Ave
Lowell, MA 01854
Phone (978) 788-7344

20 Research Pl
Ste 320
North Chelmsford, MA 01863
Phone (978) 256-1858

123 Summer St
Worcester, MA 01608
Phone (508) 363-6000

55 Lake Ave N
Worcester, MA 01655
Phone 508334100048862

Interoperability endpoints

  • Direct secure messaging: cjackson106639@tuftsmedicine.direct-ci.com
  • Direct secure messaging: cjackson60403@direct.bilh.masshiway.net
  • FHIR API: https://fhir-myrecord.cerner.com/r4/d04f75c7-2a62-4686-b520-7bf0635f38f0/

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1395792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639008000000",
    "number": "1104243278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 E CONCORD ST",
            "address_2": "6TH FLOOR",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182335",
            "telephone_number": "617-414-5166",
            "fax_number": "617-414-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 E CONCORD ST",
            "address_2": "6TH FLOOR",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182335",
            "telephone_number": "617-414-5166",
            "fax_number": "617-414-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "COLIN",
        "middle_name": "BENJAMIN",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-03-26",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MA",
            "license": "274359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "100 Hospital Rd",
            "city": "Leominster",
            "state": "MA",
            "country_code": "US",
            "postal_code": "014532253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.