Jackson Clinic LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

JACKSON CLINIC LLC

Practice address

33 Bedford St Ste 11
Lexington, MA 02420-4403

Phone

(781) 825-5390

NPI assigned

Apr 21, 2022

Last updated

Apr 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Annise Jackson, MDNPI 1770979858

Title

Ceo

Phone

(781) 825-5390

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Annise Jackson, M.D.

  • Psychiatry Physician
  • Lexington, MA
  • NPI 1770979858
  NPD Authorized official

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

{
    "created_epoch": "1650499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650499200000",
    "number": "1235873811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 2ND AVE APT 512",
            "city": "BURLINGTON",
            "state": "MA",
            "postal_code": "018034463",
            "telephone_number": "228-712-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 BEDFORD ST STE 11",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024204403",
            "telephone_number": "781-825-5390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-21",
        "last_updated": "2022-04-21",
        "certification_date": "2022-04-21",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ANNISE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "781-825-5390",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Innovate Health, LLC
• Institute for Learning and Development
• Institute for Learning and Development
• Anastasia Ivanenko, OTR/L
• David V Ives, MD
• Annise Jackson, M.D.
• Laura Jeane Jacobson, LICSW, CEAP
• Catherine Tellides Jaffee, PH.D.
• Regina Jamieson, LICSW
• Paula Ann Janes, M.S., P.T.

• Psychiatry Physician in Lexington, MA
• Providers in Lexington, MA by specialty
• Psychiatry Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.