Alvin Deron Jackson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35064673 Issued in OH

Practice address

106 E Broad St
Savannah, GA 31401-2917

Phone

(912) 527-1000

NPI assigned

Jan 4, 2006

Last updated

Jun 11, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Ohio State University College of Medicine, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Curtis V. Cooper Primary Health Care, Inc.Group PAC ID 4789667015, 32 clinicians

Effingham Rehab Services, LLCGroup PAC ID 5597752063, shared by 3 NPIs, 143 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Enhabit Home Health Home health agency, Pooler, GA, CCN 117150

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Curtis V. Cooper Primary Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
  • NPI 1750314183
  Medicare reassignment Care Compare group NPD
• Curtis V. Cooper Primary Health Care Inc.

  • Federally Qualified Health Center (FQHC)
  • Springfield, GA
  • NPI 1023804150
  NPD
• Curtis V. Cooper Primary Health Care Inc.

  dba Curtis V. Cooper Women's Health Center

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
  • NPI 1841683067
  NPD
• Curtis V. Cooper Primary Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
  • NPI 1659668010
  NPD
• Curtis V. Cooper Primary Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Savannah, GA
  • NPI 1316972599
  NPD (past)

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

• Caresouth HHA Holdings of South Carolina, LLC

  dba Enhabit Home Health

  • Home Health Agency
  • Pooler, GA
  • NPI 1649796582
  Care Compare affiliation

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

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1346228038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 E BROAD ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314012917",
            "telephone_number": "912-527-1097",
            "fax_number": "912-527-1126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 E BROAD ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314012917",
            "telephone_number": "912-527-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3101 Burnet Ave",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452293014",
            "country_code": "US",
            "telephone_number": "513-357-7289",
            "fax_number": "513-352-3939",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ALVIN",
        "middle_name": "DERON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-04",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "066163",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35064673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003172519C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jabez's Dream (Esther's House)
• Thea Elizabeth Jack, MPT,PCS
• Jackson P. Morgan, III, PC
• Kim Elizabeth Jackson-Allen, LPC,NCC,
• Alricka Jolynn Jackson, M.D.
• Calin Jackson, RBT
• Cherry Wyant Jackson
• Christopher Jackson
• Dawntaye Jackson
• Essence Jackson, LCSW, LISW-CP

• Family Medicine Physician in Savannah, GA
• Providers in Savannah, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.