Dainty J Jackson, D. O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

H0058218 Issued in MD

Practice address

11315 Pembrooke SQ Ste 112
Waldorf, MD 20603-4806

Phone

(301) 885-3350

Fax

(240) 222-3899

NPI assigned

Jun 8, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MD, DC2 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

Family PracticeAlso: General Practice, Osteopathic Manipulative Medicine

Education

West Virginia School of Osteopathic Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Jackson Family Medicine, LLC

  • Primary Care Clinic/Center
  • Waldorf, MD
  • NPI 1780825224
  Medicare reassignment NPD Authorized official
• Medpro Hospitalists LLP

  • Internal Medicine Physician
  • Cheverly, MD
  • NPI 1346279262

  DC

  Medicare reassignment
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549584000000",
    "number": "1194765834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7876",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207927876",
            "telephone_number": "301-254-8177",
            "fax_number": "240-222-3899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11315 PEMBROOKE SQ STE 112",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034806",
            "telephone_number": "301-885-3350",
            "fax_number": "240-222-3899"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Saint Patricks Dr",
            "address_2": "Suite 502",
            "address_purpose": "LOCATION",
            "city": "Waldorf",
            "state": "MD",
            "postal_code": "206034527",
            "country_code": "US",
            "telephone_number": "301-885-3350",
            "fax_number": "301-885-3352",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DAINTY",
        "middle_name": "J",
        "credential": "D. O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2019-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "H0058218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "401725102",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jackson Family Medicine, LLC
• Ruth Clarie Jackson-Hayes, M.A., L.P.C.
• Angela Jackson
• Brendalan Jackson, LCSW
• Crystal I Jackson, LGSW-G
• Gianna Latrice Jackson, GMFT
• Joyce Jacquetta Jackson, NP
• Nathaniel Jackson Jr.
• Janelle Adrienne Jacobs
• Geraldine Jessica Jaganathan, PTA

• Family Medicine Physician in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2019; 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.