Faison Jackson

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA64805 Issued in CA

Practice address

269 S San Pedro St
Los Angeles, CA 90012-3808

Phone

(213) 947-3600

NPI assigned

May 9, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Modern Physician Services PCGroup PAC ID 6204140544, 55 clinicians

Divinity Medical Services PLLCGroup PAC ID 5193030245, 92 clinicians

Urgent Care Physician of New York-Hartsdale PLLCGroup PAC ID 8628253697, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CHFABD

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.

• Modern Physician Services PC

  dba ModernMD Urgent Care

  • Urgent Care Clinic/Center
  • Brooklyn, NY
  • NPI 1932590601

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Divinity Medical Services PLLC

  dba AFC Urgent Care Yorktown

  • Urgent Care Clinic/Center
  • Yorktown Heights, NY
  • NPI 1497159560
  Medicare reassignment Care Compare group
• Urgent Care Physician of New York-Hartsdale PLLC

  dba Afc Urgent Care

  • Urgent Care Clinic/Center
  • Bronx, NY
  • NPI 1770885808
  Medicare reassignment Care Compare group
• Brookdale Hospital Medical Center

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1720028772

  Single Specialty

  Medicare reassignment NPD
• Interfaith Emergency Medicine, P.C.

  • Emergency Medicine Physician
  • Brooklyn, NY
  • NPI 1457643785
  Medicare reassignment
• The Brookdale Hospital Medical Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Brooklyn, NY
  • NPI 1639756406
  NPD

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

{
    "created_epoch": "1683590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1366132813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "269 S SAN PEDRO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900123808",
            "telephone_number": "213-947-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "269 S SAN PEDRO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900123808",
            "telephone_number": "213-947-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "FAISON",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-09",
        "last_updated": "2026-07-13",
        "certification_date": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA64805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diane Wesson Jackson, MFC
• Dijon Lamont Jackson
• Erika D Jackson, MSW
• Erin Burgos Jackson
• Evan Guy Boulware Jackson, MD
• Francina Jackson
• Gail Allsup Jackson, PHD, M.A., LMFT
• Gail N Jackson, M.D
• George Robert Jackson, MD
• Glenn Jackson Jr.

• Physician Assistant in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.