NPIMap

Individual provider Active NPI

Theresa G Jackson, MD

  • Family Medicine Physician
  • Portsmouth, VA
National Provider Identifier
1245239227
Registry record updated Jul 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101050002 Issued in VA
Practice address
3640 High St
Suite 2a
Portsmouth, VA 23707-3213
Phone
(757) 397-6930
Fax
(757) 397-4864
NPI assigned
Jul 20, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 0101050002 VA
Family Medicine Physician 207Q00000X 0101050002 VA Primary

Addresses

Primary practice location

3640 High St
Suite 2a
Portsmouth, VA 23707-3213

Mailing address

3640 High St
Suite 2a
Portsmouth, VA 23707-3213
Phone (757) 397-6930

Other identifiers 3

IdentifierTypeStateIssuer
P00799688OtherVARR MEICARE
005602785MedicaidVA
080007399OtherVAMEDICARE INDIVIDUAL PROVIDER ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081112000066 VA Practitioner - Physical Medicine and Rehabilitation 3779642368 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Eastern Virginia Medical School, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bon Secours Medical Group Hampton Roads Specialty Care LLCGroup PAC ID 3173955671, 197 clinicians

Practice addresses (Care Compare)

1040 University Blvd
Portsmouth, VA 23703-2650

150 Kingsley LN
Norfolk, VA 23505-4602
Phone (757) 398-2673

Hospital & facility affiliations

  • Bon Secours Maryview Medical Center Hospital, Portsmouth, VA, CCN 490017
  • Bon Secours Harbour View Medical Center Hospital, Suffolk, VA, CCN 490148
  • Sentara Obici Hospital Hospital, Suffolk, VA, CCN 490044
  • Bon Secours Southampton Memorial Hospital Hospital, Franklin, VA, CCN 490092
  • Sentara Norfolk General Hospital Hospital, Norfolk, VA, CCN 490007

Merit-based Incentive Payment System (MIPS)

Final score
90.02 of 100Reported as individual
Quality
80.78
Promoting interoperability
100
Improvement activities
40
Cost
85.95

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101050002VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours Medical Group Hampton Roads Specialty Care LLC CurrentSince Jan 1, 2020 Accepting new patients
Bon Secours Medical Group Hampton Roads Specialty Care LLC CurrentSince Jan 1, 2020 Accepting new patients

Locations

150 Kingsley Ln
Norfolk, VA 23505
Phone (757) 464-6944

8580 Magellan Pkwy
Richmond, VA 23227
Phone (804) 627-5462

7007 Harbour View Blvd
Ste 108
Suffolk, VA 23435
Phone (757) 215-2784

2012 Meade Pkwy
Suffolk, VA 23434
Phone (757) 539-1477

Interoperability endpoints

  • Direct secure messaging: tjackson1152267@direct.bsmhealth.org

Organizations & group practices 2

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.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753315200000",
    "number": "1245239227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3640 HIGH ST",
            "address_2": "SUITE 2A",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237073213",
            "telephone_number": "757-397-6930",
            "fax_number": "757-397-4864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3640 HIGH ST",
            "address_2": "SUITE 2A",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237073213",
            "telephone_number": "757-397-6930",
            "fax_number": "757-397-4864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "THERESA",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-20",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "VA",
            "license": "0101050002",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101050002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEICARE",
            "identifier": "P00799688",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005602785",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL PROVIDER ID",
            "identifier": "080007399",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, VA

Sources for this page

Verify at the official NPI Registry.