Tedroy Mevrick Jackson, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD61645378 Issued in WA

Practice address

2123 Auburn Ave Ste 235
Cincinnati, OH 45219-2906

Phone

(513) 585-3238

NPI assigned

Mar 23, 2022

Sex

Male

Sole proprietor

No

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

Enrolled in WA

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

Internal Medicine

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

South Sound Inpatient Physicians PLLCGroup PAC ID 5991618738, 424 clinicians

Galen Inpatient Physicians PCGroup PAC ID 3678464633, 1,045 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Skagit Valley Hospital Hospital, Mount Vernon, WA, CCN 500003
• Cascade Valley Hospital Hospital, Arlington, WA, CCN 500060

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tjackson63372@skagit.direct-ci.com

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.

• South Sound Inpatient Physicians PLLC

  • Internal Medicine Physician
  • Vancouver, WA
  • NPI 1023285756
  Medicare reassignment Care Compare group NPD
• Galen Inpatient Physicians PC

  • Hospitalist Physician
  • Everett, WA
  • NPI 1255261715
  Care Compare group
• The Christ Hospital Medical Associates, LLC

  • Internal Medicine Physician
  • Cincinnati, OH
  • NPI 1114107919
  NPD
• University of Cincinnati Physicians Company, LLC

  • Family Medicine Physician
  • Cincinnati, OH
  • NPI 1801840434

  Internal Medicine

  NPD
• South Sound Inpatient Physicians PLLC

  • Internal Medicine Physician
  • Hillsboro, OR
  • NPI 1508023789
  NPD
• South Sound Inpatient Physicians PLLC

  • Internal Medicine Physician
  • Bremerton, WA
  • NPI 1831366566
  NPD
• Public Hospital Dist No 1 Skagit

  • General Acute Care Hospital
  • Mount Vernon, WA
  • NPI 1053357244
  NPD (past)

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

• Public Hospital Dist No 1 Skagit

  • General Acute Care Hospital
  • Mount Vernon, WA
  • NPI 1053357244
  Care Compare affiliation
• Public Hospital Dist No 1 Skagit

  • General Acute Care Hospital
  • Arlington, WA
  • NPI 1073566246
  Care Compare affiliation

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

{
    "created_epoch": "1647993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781049600000",
    "number": "1356091490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2123 AUBURN AVE STE 340",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452192906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2123 AUBURN AVE STE 235",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452192906",
            "telephone_number": "513-585-3238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TEDROY",
        "middle_name": "MEVRICK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-23",
        "last_updated": "2026-06-10",
        "certification_date": "2026-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD61645378",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "WA",
            "license": "MD.MD.61645378",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sonnetta Kay Jackson, LPN
• St.John Jackson
• Susan Marie Jackson, CNP
• Tamika Jackson
• Tangie Jackson
• Terrence Jackson
• Thomas Jackson
• Tiffani Jackson
• Tony Jackson
• Valante Jackson

• Internal Medicine Physician in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2026; 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.