Susan Dee Jackson, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

48410 Issued in KY

Practice address

401 E Chestnut St Unit 310
Louisville, KY 40202-5703

Phone

(502) 588-4720

NPI assigned

Apr 4, 2012

Sex

Female

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

Other names 1

• Susan Dee Former name

Medicare fee-for-service enrollment

Enrolled in KY

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

University of Louisville School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Louisville Physicians IncGroup PAC ID 3476725599, 1,438 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University of Louisville Hospital Hospital, Louisville, KY, CCN 180141

Merit-based Incentive Payment System (MIPS)

Final score

78.96 of 100Reported as group

Quality

56.12

Promoting interoperability

100

Improvement activities

40

Cost

73.73

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• University of Louisville Physicians, Inc.

  • Internal Medicine Physician
  • Louisville, KY
  • NPI 1366722316
  Medicare reassignment Care Compare group NPD
• University of Louisville Physicians, Inc.

  • Diagnostic Radiology Physician
  • Louisville, KY
  • NPI 1316294127
  NPD
• University of Louisville Physicians, Inc.

  • Psychiatry Physician
  • Louisville, KY
  • NPI 1831443472
  NPD
• University Medical Center, Inc

  • General Acute Care Hospital
  • Louisville, KY
  • NPI 1861554438

  Student in an Organized Health Care Education/Training Program

  NPD (past)

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

• University Medical Center, Inc

  • General Acute Care Hospital
  • Louisville, KY
  • NPI 1861554438
  Care Compare affiliation

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

{
    "created_epoch": "1333497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626652800000",
    "number": "1356607295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 909",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402010909",
            "telephone_number": "502-588-4720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E CHESTNUT ST UNIT 310",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402025703",
            "telephone_number": "502-588-4720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SUSAN",
        "middle_name": "DEE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-04",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "48410",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100249880",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "DEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sameera Chowdhury Jackson, LPCA
• Sarah E Jackson, M.A.
• Shaniya Jackson, RBT
• Shelita Renee Jackson
• Shereka M Jackson, LCSW
• Tara Jackson
• Tyrza Nicole Jackson, BS, RBT
• Gabrielle Bella Oropilla Jacob, MD
• Kevin Jacob, BS
• Neville Kallarackel Jacob, BDS,DDS

• Internal Medicine Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Internal Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2021; 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.