NPIMap

Individual provider Active NPI

Lyle Thomas Jackson Jr., M.D.

  • Orthopaedic Foot and Ankle Surgery Physician
  • Eugene, OR
National Provider Identifier
1144540790
Registry record updated Dec 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Foot and Ankle Surgery PhysicianTaxonomy code 207XX0004X
License
MD176209 Issued in OR
Practice address
55 Coburg Rd
Eugene, OR 97401-2433
Phone
(541) 485-8111
NPI assigned
Jun 6, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Foot and Ankle Surgery Physician 207XX0004X 16057 NV
Orthopaedic Foot and Ankle Surgery Physician 207XX0004X MD176209 OR Primary
Orthopaedic Surgery Physician 207X00000X 32738 SC
Orthopaedic Surgery Physician 207X00000X 16057 NV

Addresses

Primary practice location

55 Coburg Rd
Eugene, OR 97401-2433

Mailing address

55 Coburg Rd
Eugene, OR 97401-2433
Phone (541) 485-8111

Other practice location 1

555 N Arlington Ave
Reno, NV 89503-4723
Phone (775) 786-3040

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20160802002711 OR Practitioner - Orthopedic Surgery 6103075486 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Washington School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Slocum Orthopedics PCGroup PAC ID 0547164758, 67 clinicians

Practice addresses (Care Compare)

55 Coburg Rd
Eugene, OR 97401-2433
Phone (541) 485-8111

Hospital & facility affiliations

  • Signature Healthcare at Home Home health agency, Eugene, OR, CCN 387140
  • McKenzie-Willamette Medical Center Hospital, Springfield, OR, CCN 380020
  • Sacred Heart Medical Center - Riverbend Hospital, Springfield, OR, CCN 380102
  • Lower Umpqua Hospital District Hospital, Reedsport, OR, CCN 381311
  • Peace Harbor Medical Center Hospital, Florence, OR, CCN 381316

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
93.65 of 100Reported as group
Quality
86.8
Promoting interoperability
100
Improvement activities
40
Cost
86.36

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement12
Knee replacement12
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Removal of tissue46
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16057NVMDOrthopaedic Foot and Ankle Surgery Physician
MD176209ORMDOrthopaedic Foot and Ankle Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Slocum Orthopedics, PC Orthopaedic Surgery CurrentSince Aug 1, 2016 Accepting new patients
Slocum Orthopedics, PC Orthopaedic Surgery CurrentSince Aug 1, 2016 Accepting new patients
McKenzie-Willamette Regional Medical Center Associates LLC Past Accepting new patients

Locations

55 Coburg Rd
Eugene, OR 97401
Phone (541) 485-8111

Interoperability endpoints

  • Direct secure messaging: ljacks81@yourcarecommunity.org
  • Direct secure messaging: lyle.jacksonmd.p1@direct.slocumcenter.nextgenshare.com

Organizations & group practices 3

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.

Hospital & facility affiliations 6

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": "1275782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672099200000",
    "number": "1144540790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 COBURG RD",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974012433",
            "telephone_number": "541-485-8111",
            "fax_number": "541-342-6379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 COBURG RD",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974012433",
            "telephone_number": "541-485-8111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "555 N Arlington Ave",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895034723",
            "country_code": "US",
            "telephone_number": "775-786-3040",
            "fax_number": "775-786-1358",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LYLE",
        "middle_name": "THOMAS",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-06",
        "last_updated": "2022-12-27",
        "certification_date": "2022-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0004X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": "NV",
            "license": "16057",
            "primary": false
        },
        {
            "code": "207XX0004X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": "OR",
            "license": "MD176209",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "SC",
            "license": "32738",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NV",
            "license": "16057",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eugene, OR

Sources for this page

Verify at the official NPI Registry.