Chad Harman Jackson, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

M-15230 Issued in ID

Practice address

111 W Main St Ste 200
Boise, ID 83702-7308

Phone

(208) 344-3220

Fax

(208) 344-0461

NPI assigned

Apr 17, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI, ID2 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

Ophthalmology

Education

University of Kentucky College of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Idaho Eyelid and Facial Plastic Surgery PLLCGroup PAC ID 3375457906, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: idahoeyelidfacialplasticsurgery.chadjackson@149618.advancedmd-direct.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.

• Idaho Eyelid & Facial Plastic Surgery , PLLC

  • Ophthalmology Physician
  • Boise, ID
  • NPI 1255401436
  Medicare reassignment Care Compare group NPD
• The Medical College of Wisconsin, Inc.

  • Internal Medicine Physician
  • Milwaukee, WI
  • NPI 1699720086
  Medicare reassignment NPD
• Mountain View Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Meridian, ID
  • NPI 1962257048
  NPD (past)

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

• St Lukes Regional Medical Center

  • Ambulance
  • Boise, ID
  • NPI 1518115195

  Hospital

  Care Compare affiliation
• St Lukes Regional Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  Care Compare affiliation

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

{
    "created_epoch": "1366156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1184067498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W MAIN ST STE 200",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027308",
            "telephone_number": "208-344-3220",
            "fax_number": "208-344-0461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W MAIN ST STE 200",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027308",
            "telephone_number": "208-344-3220",
            "fax_number": "208-344-0461"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4502 Medical Dr",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782294402",
            "country_code": "US",
            "telephone_number": "210-567-8406",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "925 N 87th St",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532264812",
            "country_code": "US",
            "telephone_number": "414-456-2020",
            "fax_number": "414-456-6300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5435 Reno Corporate Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895112250",
            "country_code": "US",
            "telephone_number": "775-322-3311",
            "fax_number": "775-322-8388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHAD",
        "middle_name": "HARMAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-17",
        "last_updated": "2022-07-21",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "WI",
            "license": "67198",
            "primary": false
        },
        {
            "code": "207WX0200X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": "NV",
            "license": "18691",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "ID",
            "license": "M-15230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184067498",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jane Jablonski, LPC
• Jackie Nelson, PLLC
• Shelley Marie Jacks, MD
• Ashley Jackson, PHARMD
• Caleb Jackson
• Derek Dean Jackson, MD
• Elizabeth A Jackson, LCSW
• John A Jackson, M.D.
• Keri Lynn Jackson, M.D.
• Leah Jackson, ARNP

• Ophthalmology Physician in Boise, ID
• Providers in Boise, ID by specialty
• Ophthalmology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.