Active NPI
Jacqueline Ross, MD
- Emergency Medicine Physician
- Augusta, GA
National Provider Identifier
1376334862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 17613
- Practice address
- 1120 15TH St
Augusta, GA 30912-0004 - Phone
- (706) 721-4951
- NPI assigned
- May 14, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 17613 | GA | Primary |
Addresses
Primary practice location
1120 15TH St
Augusta, GA 30912-0004
Mailing address
1465 Laney Walker Blvd
Augusta, GA 30912-0002
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250724001838 | GA | Order and Referring Only - Emergency Medicine | 9931616034 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747180800000",
"number": "1376334862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1465 LANEY WALKER BLVD",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309120002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 15TH ST",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309120004",
"telephone_number": "706-721-4951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSS",
"first_name": "JACQUELINE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-05-14",
"last_updated": "2025-05-14",
"certification_date": "2025-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "GA",
"license": "17613",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.