Melanie Jackson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

003328-1 Issued in NY

Practice address

10201 66TH Rd
OB/GYN Dept 3Rd Floor
Forest Hills, NY 11375-2029

Phone

(718) 830-1030

Fax

(718) 830-1089

NPI assigned

Aug 30, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Physician Assistant

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678

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.

• North Shore-Lij Medical PC

  • Urology Physician
  • Great Neck, NY
  • NPI 1053688572
  Medicare reassignment Care Compare group
• Mount Sinai School of Medicine

  • Internal Medicine Physician
  • Oceanside, NY
  • NPI 1508127531
  Medicare reassignment NPD
• Mount Sinai School of Medicine

  • Psychiatry Physician
  • Hempstead, NY
  • NPI 1508333956
  NPD
• North Shore - Lij Medical PC

  • Internal Medicine Physician
  • New Hyde Park, NY
  • NPI 1790043479
  NPD

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

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189468800000",
    "number": "1134313364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 COLONIAL RD",
            "city": "W HEMPSTEAD",
            "state": "NY",
            "postal_code": "115524113",
            "telephone_number": "516-629-4243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10201 66TH RD",
            "address_2": "OB/GYN DEPT 3RD FLOOR",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113752029",
            "telephone_number": "718-830-1030",
            "fax_number": "718-830-1089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MELANIE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-30",
        "last_updated": "2007-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "003328-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carla Jack, LMHC
• Camille Jackson
• Christopher Jackson, LMHC
• Kamala Eva-Marie Jackson, LMSW
• Lauryn Williams Jackson, LMSW
• Adam Jacob, DO
• Flora Jacobson, L.C.S.W.
• Selena Jacobsonperez, LCSW
• Jacqueline Shalamov Occupational Therapy P.C.
• Ishrat Jahan

• Physician Assistant in Forest Hills, NY
• Providers in Forest Hills, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2007; 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.