Kyle Jackson, M.D., PH.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MD485481 Issued in PA

Practice address

3400 Spruce Street
4 Silverstein
Philadelphia, PA 10104-4206

Phone

(215) 615-4949

Fax

(215) 662-2244

NPI assigned

Mar 25, 2014

Sex

Male

Sole proprietor

Yes

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 GA, PA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

General Surgery

Education

University of Pittsburgh School of Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Children'S Surgical Associates LTDGroup PAC ID 9739083494, 53 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Penn Medicine Home Health Home health agency, Bala Cynwyd, PA, CCN 397125
• Hospital of Univ of Pennsylvania Hospital, Philadelphia, PA, CCN 390111

Merit-based Incentive Payment System (MIPS)

Final score

84.91 of 100Reported as group

Quality

73.58

Promoting interoperability

100

Improvement activities

40

Cost

76.13

Merit-based Incentive Payment System (MIPS)

Final score

94.51 of 100Reported as apm

Quality

80.61

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Children'S Surgical Associates LTD

  • Plastic Surgery Physician
  • Philadelphia, PA
  • NPI 1326117185
  Medicare reassignment Care Compare group NPD
• University of Penn-Medical Group

  • Gynecologic Oncology Physician
  • Philadelphia, PA
  • NPI 1235527342
  Medicare reassignment Care Compare group NPD
• Choa Hospital Based, LLC

  • Pediatrics Physician
  • Brookhaven, GA
  • NPI 1457695488
  Medicare reassignment NPD
• Children'S Surgical Associates LTD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Philadelphia, PA
  • NPI 1730268079
  NPD
• University of Penn-Medical Group

  • Surgery Physician
  • Philadelphia, PA
  • NPI 1548658560
  NPD
• University of Penn-Medical Group

  • Surgical Oncology Physician
  • Philadelphia, PA
  • NPI 1871981985
  NPD
• Choa Multispecialty, LLC

  • Pediatrics Physician
  • Brookhaven, GA
  • NPI 1437493467
  NPD
• Children'S Surgical Associates LTD

  • Pediatric Surgery Physician
  • Philadelphia, PA
  • NPI 1760562581
  NPD (past)
• Trustees of the University of Pennsylvania

  • General Acute Care Hospital
  • Philadelphia, PA
  • NPI 1851370910
  NPD (past)
• University of Penn - Medical Group

  • Cardiovascular Disease Physician
  • Philadelphia, PA
  • NPI 1093725145
  NPD (past)
• Emory Health Care

  • Neurology Physician
  • Atlanta, GA
  • NPI 1376642751
  NPD (past)

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

• Hospital of the University of PA

  • Ambulatory Fertility Facility
  • Phila, PA
  • NPI 1033262316

  Hospital

  Care Compare affiliation
• Presbyterian Medical Center of the University of Pennsylvania Health S

  • Home Health Agency
  • Bala Cynwyd, PA
  • NPI 1992746366
  Care Compare affiliation
• Trustees of the University of Pennsylvania

  • General Acute Care Hospital
  • Philadelphia, PA
  • NPI 1851370910
  Care Compare affiliation

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

{
    "created_epoch": "1395705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1164849352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "address_2": "4 SILVERSTEIN",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "101044206",
            "telephone_number": "215-615-4949",
            "fax_number": "215-662-2244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 SPRUCE STREET",
            "address_2": "4 SILVERSTEIN",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "101044206",
            "telephone_number": "215-615-4949",
            "fax_number": "215-662-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KYLE",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-03-25",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD485481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katrina Jackson
• Kelly Jackson
• Kendall Jackson, MD
• Khamyia Yvette Jackson
• Kirk Raymond Jackson Jr., MD
• Lynette Jackson
• Maisie Lee Jackson, MD
• Marguerite Jackson, M.ED, BCPC
• Melodie Isma Jackson
• Melody Jackson

• Surgery Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Surgery Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 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.