Pharnethia Goodman Jackson, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024164290 Issued in VA

Practice address

2760 Godwin Blvd Ste 100
Suffolk, VA 23434-8501

Phone

(757) 983-8650

NPI assigned

Jan 29, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sentara Home Care Services-Suffolk Home health agency, Suffolk, VA, CCN 497746
• Sentara Obici Hospital Hospital, Suffolk, VA, CCN 490044
• Sentara Albemarle Medical Center Hospital, Elizabeth City, NC, CCN 340109
• Sentara Norfolk General Hospital Hospital, Norfolk, VA, CCN 490007

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pjackson118550@direct.sentara.net

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.

• Sentara Medical Group

  • Family Medicine Physician
  • Norfolk, VA
  • NPI 1265485270
  Medicare reassignment Care Compare group NPD
• Comprehensive Medical Center I Inc

  • Family Medicine Physician
  • Virginia Beach, VA
  • NPI 1073524484
  NPD (past)

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

• Sentara Enterprises

  • Home Health Agency
  • Suffolk, VA
  • NPI 1174060214
  Care Compare affiliation
• Sentara Hospitals

  • Air Ambulance
  • Norfolk, VA
  • NPI 1235205147

  Hospital

  Care Compare affiliation
• Sentara Hospitals

  • General Acute Care Hospital
  • Suffolk, VA
  • NPI 1376540138
  Care Compare affiliation
• Sentara Hospitals

  • General Acute Care Hospital
  • Norfolk, VA
  • NPI 1437119310
  Care Compare affiliation
• Sentara Albemarle Regional Medical Center

  • General Acute Care Hospital
  • Elizabeth City, NC
  • NPI 1245211168
  Care Compare affiliation

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1124164173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2760 GODWIN BLVD STE 100",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348501",
            "telephone_number": "757-983-8650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2760 GODWIN BLVD STE 100",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348501",
            "telephone_number": "757-983-8650"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2050 Hillpoint Blvd N",
            "address_purpose": "LOCATION",
            "city": "Suffolk",
            "state": "VA",
            "postal_code": "234347181",
            "country_code": "US",
            "telephone_number": "757-934-3434",
            "fax_number": "757-538-9038",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PHARNETHIA",
        "middle_name": "GOODMAN",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "VA",
            "license": "0001120025",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0017137032",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024164290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ayumi Jackson
• Christina Michelle Jackson, DO
• Jerome Christopher Jackson
• Julian Myles Jackson
• Lacrezia Jackson, LCSW
• Vanessa Jackson
• William G Jackson, MD
• Malik Jaggard
• Muna A Jama, MD
• James Alan Taylor

• Family Nurse Practitioner in Suffolk, VA
• Providers in Suffolk, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; 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.