Frederic Leslie Jackson, DO, MPH

Primary specialty

Hospice and Palliative Medicine (Family Medicine) PhysicianTaxonomy code 207QH0002X

License

20A10056 Issued in CA

Practice address

2402 Old Ranch Rd
Escondido, CA 92027-6727

Phone

(760) 855-5423

Fax

(877) 359-0651

NPI assigned

Nov 28, 2006

Last updated

Dec 13, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Elizabeth Supportive Medical Specialists, a Medical Corporation

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Escondido, CA
  • NPI 1154861979
  NPD (past)
• The Elizabeth Hospice, Inc.

  • Community Based Hospice Care Agency
  • Escondido, CA
  • NPI 1538168950

  Family Medicine

  NPD (past)
• Athens Family Medicine LLC

  • Family Medicine Physician
  • Athens, GA
  • NPI 1427418391
  NPD (past)
• Fort Wayne Medical Education Program

  dba The Family Medicine Center

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1184635153
  NPD (past)

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229126400000",
    "number": "1255407318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2402 OLD RANCH RD",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920276727",
            "telephone_number": "760-855-5423",
            "fax_number": "877-359-0651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2402 OLD RANCH RD",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920276727",
            "telephone_number": "760-855-5423",
            "fax_number": "877-359-0651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "FREDERIC",
        "middle_name": "LESLIE",
        "credential": "DO, MPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2008-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0102032316",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS0004196",
            "primary": false
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "CA",
            "license": "20A10056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ivita, LLC
• Ivy Dell Ranch
• Anushka Iyer
• Aisha Jabarkhiel
• Autumn Lynn Jackson
• Kambria Kelley Jackson, LVN
• Teresa E Jackson
• Eleni Jacobs
• Harold Sidney Jacobs, M.D.
• Pamela Jacobs

• Hospice and Palliative Medicine (Family Medicine) Physician in Escondido, CA
• Providers in Escondido, CA by specialty
• Hospice and Palliative Medicine (Family Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2008; 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.