Jackson Deen, PA
Individual provider Active NPI Physician Assistant · Gloucester, VA
NPI 1154891174 · NPPES record last updated Dec 3, 2018
Key facts
- NPI
- 1154891174
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 7519 Hospital Dr
Gloucester, VA 23061-4178 - Phone
- (804) 693-8899
- Fax
- (804) 693-8810
- NPI assigned
- Dec 3, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare Care Compare profile
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.91 of 100
- Quality
- 92.86
- Promoting interoperability
- 94.93
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190221002594 | VA | Practitioner - Physician Assistant | 4880933696 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riverside Physician Services Inc | Current |
Accepting new patients | |
| Riverside Physician Services Inc | Current |
Accepting new patients | |
| Riverside Physician Services Inc | Past | Accepting new patients |
Locations
7519 Hospital Dr
Gloucester, VA 23061
Phone (804) 693-8800
856 J Clyde Morris Blvd
Ste A
Newport News, VA 23601
Phone (757) 316-5900
858 J Clyde Morris Blvd
Newport News, VA 23601
Phone (757) 594-4343
1500 Commonwealth Ave
Williamsburg, VA 23185
Phone (757) 585-2200
Interoperability endpoints
- jdeen119811@direct.rivhs.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
7519 Hospital Dr
Gloucester, VA 23061-4178
Mailing address
856 J Clyde Morris Blvd Ste a
Newport News, VA 23601-1318
Phone (757) 316-5800
Other providers in Gloucester, VA
- Sabrina Gertrude Curry
- Daniel E Pouchot, DDS, PLLC
- Jill Daniel
- Angela Davidson
- Robert Thomas Davis
- Janet Hudgins Dehoux
- Kimberley Ann Denham
- Kira Maria Derby
- Dermatology Consultants of Gloucester P L L C
- Frances Elizabeth Dickinson
All providers in Gloucester, VA · Physician Assistant in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.