Jackson Macdonald, PA-C
Individual provider Active NPI Physician Assistant · Westerville, OH
NPI 1194477646 · NPPES record last updated Jan 25, 2022
Key facts
- NPI
- 1194477646
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 50.007418RX (OH)
- Practice address
- 575 Copeland Mill Rd Ste 1D
Westerville, OH 43081-8977 - Phone
- (614) 794-0481
- NPI assigned
- Jan 25, 2022
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 7
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Memorial Hospital of Union County
Wedgewood Urgent Care, LTD
Practice addresses (Care Compare)
1958 E US Hwy 36
Urbana, OH 43078-9799
Phone (937) 652-5019
444 N Cleveland Ave
Westerville, OH 43082-8388
Phone (614) 839-1118
4460 Lake Forest Dr
Suite 216
Blue Ash, OH 45242-3755
Phone (513) 281-4400
Hospital & facility affiliations
- Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- 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 |
|---|---|---|---|---|
| I20220408000786 | OH | Practitioner - Physician Assistant | 4183010614 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50.007418RX | OH | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hospital of Union County | Current |
Accepting new patients | |
| Memorial Hospital of Union County | Current |
Accepting new patients | |
| Immediate Health Associates | Past |
Accepting new patients |
Locations
120 Colemans Crossing Blvd
Ste B
Marysville, OH 43040
Phone (937) 578-4310
1958 E US Highway 36
Urbana, OH 43078
Phone (937) 652-1834
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 50.007418RX | OH | Yes |
Addresses
Primary practice location
575 Copeland Mill Rd Ste 1D
Westerville, OH 43081-8977
Mailing address
4103 Berrybush Dr
Columbus, OH 43230-5108
Other providers in Westerville, OH
- LW Care LLC
- Lyle T Olson MD Inc
- Lynn a Monstwil DDS Inc
- Elizabeth Bernadean Lyons
- Nancy Lytle
- Robert James Macielak
- Latisha Mackey
- Shelby Mackey
- Barbara Mackinaw-Koons
- Alison Louise Mackinlay
All providers in Westerville, OH · Physician Assistant in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 2022. 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.