Tracy Letia Jackson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

006032-1 Issued in NY

Practice address

215 W 125TH St
New York, NY 10027-4426

Phone

(212) 939-3566

NPI assigned

Feb 7, 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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

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

Interoperability endpoints

• Direct secure messaging: tracy.jackson@vipcs.eclinicaldirectplus.com

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.

• Vocational Instruction Project Community Services, Inc.

  • Methadone Clinic
  • Bronx, NY
  • NPI 1881733830
  Medicare reassignment NPD
• Kings Medical Family Practice PC

  • Family Medicine Physician
  • Brooklyn, NY
  • NPI 1316461387
  Medicare reassignment
• Ag Urgent Care, P.C.

  • Urgent Care Clinic/Center
  • Brooklyn, NY
  • NPI 1992116701
  NPD (past)
• Vocational Instruction Project Community Services Inc

  • Clinic/Center
  • Bronx, NY
  • NPI 1164880423
  NPD (past)

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542585600000",
    "number": "1154461283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CITY COLLEGE OF NEW YORK",
            "address_2": "160 CONVENT AVENUE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10031",
            "telephone_number": "212-690-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 W 125TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100274426",
            "telephone_number": "212-939-3566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TRACY",
        "middle_name": "LETIA",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-07",
        "last_updated": "2018-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "006032-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawnmarie Loreen Jackson, NP
• Sherry Jackson, M.D.
• Susan Jackson, LMSW
• Tanaisha Jackson
• Tiwana Jackson
• Unnati Jackson, PA
• Vanessa Mari Jackson
• William Michael Jackson, M.D.
• Yazmyne Jackson
• Taylor Nicole Jackvony

• Physician Assistant in New York, NY
• Providers in New York, 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 Nov 19, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.