Melody Jackson

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

61203601 Issued in PA

Practice address

1667 N Allison St
Philadelphia, PA 19131-3530

Phone

(267) 658-9971

NPI assigned

Oct 25, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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 and National Provider Directory roles.

• Javinnis Angles

  • Home Health Aide
  • Philadelphia, PA
  • NPI 1053066688
  NPD

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

{
    "created_epoch": "1635120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653264000000",
    "number": "1316601511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1667 N ALLISON ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191313530",
            "telephone_number": "267-658-9971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1667 N ALLISON ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191313530",
            "telephone_number": "267-658-9971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MELODY",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-25",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "PA",
            "license": "61203601",
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Homemaker",
            "state": "PA",
            "license": "61203601",
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "PA",
            "license": "61203601",
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "PA",
            "license": "61203601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "61203601",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Tablet",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1667 N Allison St",
            "city": "Philadelphia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "191313530",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kyle Jackson, M.D., PH.D.
• Lynette Jackson
• Maisie Lee Jackson, MD
• Marguerite Jackson, M.ED, BCPC
• Melodie Isma Jackson
• Michelle Jackson, LCSW
• Nicole Janice Jackson, MD
• Nora Jackson
• Oksana Jackson, MD
• Paula Deaun Jackson, CRNP

• In Home Supportive Care Agency in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• In Home Supportive Care Agency in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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.