NPIMap

Individual provider Active NPI

Lesley M Jackson, MD

  • Family Medicine Physician
  • Morehead, KY
National Provider Identifier
1336552892
Registry record updated Aug 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
TP037 Issued in KY
Practice address
316 W 2ND St
Morehead, KY 40351-1550
Phone
(606) 784-3771
Fax
(606) 783-6847
NPI assigned
Jun 3, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 36869 SC
Family Medicine Physician 207Q00000X TP037 KY Primary

Addresses

Primary practice location

316 W 2ND St
Morehead, KY 40351-1550

Mailing address

316 W Second St
Morehead, KY 40351-1550
Phone (606) 784-6641

Other identifiers 1

IdentifierTypeStateIssuer
TP037OtherKYMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20150706001187 SC Practitioner - Family Practice 6709198716 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kentucky College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Self Medical GroupGroup PAC ID 6002953916, 393 clinicians

Practice addresses (Care Compare)

1325 Spring St
Greenwood, SC 29646-3860
Phone (864) 725-4111

160 Academy Ave
Greenwood, SC 29646-3808
Phone (864) 223-8090

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
TP037KYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Self Medical Group Current Accepting new patients
Self Medical Group Family Medicine CurrentSince Jul 1, 2015 Accepting new patients
Self Medical Group CurrentSince Jul 1, 2015 Accepting new patients
Self Regional Healthcare Past Accepting new patients
St. Claire Medical Center Inc. Past Accepting new patients
St. Claire Medical Center, Inc Past Accepting new patients
Self Regional Healthcare Past Accepting new patients

Locations

75 Remittance Dr
Dept 6875
Chicago, IL 60675

75 Remittance Dr
Dept 6764
Chicago, IL 60675

1325 Spring St
Greenwood, SC 29646
Phone (864) 227-4111

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

Organizations & group practices 7

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 7

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

NPI Registry JSON

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

{
    "created_epoch": "1401753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1504051200000",
    "number": "1336552892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 W SECOND ST",
            "city": "MOREHEAD",
            "state": "KY",
            "postal_code": "403511550",
            "telephone_number": "606-784-6641",
            "fax_number": "606-783-6847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 W 2ND ST",
            "city": "MOREHEAD",
            "state": "KY",
            "postal_code": "403511550",
            "telephone_number": "606-784-3771",
            "fax_number": "606-783-6847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LESLEY",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-03",
        "last_updated": "2017-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "36869",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "TP037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "TP037",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morehead, KY

Sources for this page

Verify at the official NPI Registry.