Ivan D. Jackson, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

11508 Issued in AL

Practice address

210 Westside Dr
Dothan, AL 36303-1928

Phone

(334) 793-5074

Fax

(334) 793-6460

NPI assigned

May 23, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AL

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 1

Specialty

Internal Medicine

Education

University of South Alabama College of Medicine, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wiregrass Clinic LLCGroup PAC ID 2860662491, 69 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Enhabit Home Health Home health agency, Dothan, AL, CCN 017053
• Centerwell Home Health Home health agency, Dothan, AL, CCN 017164
• Gentiva Hospice, Enterprise, AL, CCN 011522
• Flowers Hospital Hospital, Dothan, AL, CCN 010055
• Southeast Health Medical Center Hospital, Dothan, AL, CCN 010001

Merit-based Incentive Payment System (MIPS)

Final score

87.97 of 100Reported as apm

Quality

75.95

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ivan.jackson.1@3326.direct.athenahealth.com
• Direct secure messaging: ivan.jackson.2@3326.direct.athenahealth.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.

• Wiregrass Clinic LLC

  • Neurological Surgery Physician
  • Dothan, AL
  • NPI 1558657890

  Internal Medicine

  Medicare reassignment Care Compare group NPD

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

• Caresouth HHA Holdings of Dothan, LLC

  dba Enhabit Home Health

  • Home Health Agency
  • Dothan, AL
  • NPI 1770561268
  Care Compare affiliation
• Centerwell Certified Healthcare Corp.

  dba Centerwell Home Health

  • Home Health Agency
  • Dothan, AL
  • NPI 1467489385
  Care Compare affiliation
• Houston County Healthcare Authority

  dba Southeast Alabama Medical Center

  • General Acute Care Hospital
  • Dothan, AL
  • NPI 1164403861
  Care Compare affiliation
• Triad of Alabama LLC

  dba Flowers Hospital

  • General Acute Care Hospital
  • Dothan, AL
  • NPI 1801830500
  Care Compare affiliation
• Wiregrass Hospice, LLC

  dba Gentiva

  • Community Based Hospice Care Agency
  • Dothan, AL
  • NPI 1770519324
  Care Compare affiliation

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614729600000",
    "number": "1205839362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 WESTSIDE DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363031928",
            "telephone_number": "334-793-5074",
            "fax_number": "334-793-6460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 WESTSIDE DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363031928",
            "telephone_number": "334-793-5074",
            "fax_number": "334-793-6460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "IVAN",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-23",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "11508",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000015699",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110082048",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ivan.jackson.1@3326.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "Athena EMR",
            "address_1": "210 Westside Dr",
            "city": "Dothan",
            "state": "AL",
            "country_code": "US",
            "postal_code": "363031928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• J. C. McCleod, M.D., Psychiatric, PLLC
• Jacks Enterprises-Dothan Inc (Jacks Drugs-Dothan)
• Barbara D Jackson
• Daniel Forrest Jackson III, MD
• Darbi S. Jackson, P.T.
• Jeannie Elizabeth Jacobs-Grier, PA
• Ann Liebert Jacobs, PHD
• Laurel Jacobs
• Kai Thomas Jacobson, M.D.
• Shabana M Jaffri

• Internal Medicine Physician in Dothan, AL
• Providers in Dothan, AL by specialty
• Internal Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2021; 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.