Marylee Jackson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

509 Issued in SC

Practice address

3 Saint Francis Dr Ste 360
Greenville, SC 29601-3972

Phone

(864) 232-4349

Fax

(864) 233-8103

NPI assigned

Jun 10, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Medical University of South Carolina College of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bon Secours Medical Group Greenville Specialty Care LLCGroup PAC ID 1850779976, 290 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Interim Healthcare of the Upstate Home health agency, Greenville, SC, CCN 427015

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mjackson1152262@direct.bsmhealth.org

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.

• Bon Secours Medical Group Greenville Specialty Care LLC

  • Cardiovascular Disease Physician
  • Greenville, SC
  • NPI 1821679580
  Medicare reassignment Care Compare group NPD
• Bon Secours Medical Group Greenville Specialty Care LLC

  • Orthopaedic Surgery Physician
  • Fountain Inn, SC
  • NPI 1760361174
  NPD

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

• Inspirium Ihc Upstate, LLC

  • Home Health Agency
  • Greenville, SC
  • NPI 1750897609
  Care Compare affiliation

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459468800000",
    "number": "1215978044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25039",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296160039",
            "telephone_number": "864-233-4349",
            "fax_number": "864-232-8103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 SAINT FRANCIS DR STE 360",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296013972",
            "telephone_number": "864-232-4349",
            "fax_number": "864-233-8103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARYLEE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-10",
        "last_updated": "2016-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "SC",
            "license": "8826",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "509",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0037PA",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3337PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Miles Jackson, AUD
• Kirstie Brooke Jackson
• Kristen Staples Jackson, MCD
• Lauren Elizabeth Jackson, M.S., CCC-SLP
• Mark R Jackson, MD
• Michelle Antonia Jackson
• Nina Katherine Trent Jackson, PA-C
• Samuel Collins Jackson, DPT
• Tiffany Michelle Jackson, LPN
• Timothy G Jackson, MMFT, LMFT-A

• Physician Assistant in Greenville, SC
• Providers in Greenville, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2016; 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.