Nathan Andrew Merl Jackson, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

1376805821 Issued in VA

Practice address

117 Executive Dr
Danville, VA 24541-4101

Phone

(434) 792-0423

NPI assigned

Jun 11, 2012

Last updated

Oct 19, 2021By 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

Medicare fee-for-service enrollment

Enrolled in VA

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

Dermatology

Education

West Virginia School of Osteopathic Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Complexions Dermatology, PCGroup PAC ID 5294977401, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sovah Health Danville Hospital, Danville, VA, CCN 490075

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Complexions Dermatology, PC

  • Dermatology Physician
  • Danville, VA
  • NPI 1538502828
  Medicare reassignment Care Compare group NPD

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

• Danville Regional Medical Center LLC

  dba SOVAH Health Martinsville

  • General Acute Care Hospital
  • Martinsville, VA
  • NPI 1386720183
  Care Compare affiliation
• Danville Regional Medical Center, LLC

  dba SOVAH Health Danville

  • Rural Acute Care Hospital
  • Danville, VA
  • NPI 1154419737
  Care Compare affiliation

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

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634601600000",
    "number": "1376805812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4545 RIVERSIDE DR STE D",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245415173",
            "telephone_number": "434-792-0423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 EXECUTIVE DR",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245414101",
            "telephone_number": "434-792-0423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "NATHAN",
        "middle_name": "ANDREW MERL",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-11",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "VA",
            "license": "1376805821",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OT014572",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Interventions of Virginia
• Koni Isaac, MD
• Heba Ahmed Ismail, BDS,MS
• Carolyn Howard Jack, O.T.
• Eugene F Jackson
• Parisha Jackson
• Wiley Jackson, RPH
• Tejaswi Jada, MBBS
• Vinitkumar Jalandhara, MD
• James R Evans DDS PC

• Dermatology Physician in Danville, VA
• Providers in Danville, VA by specialty
• Dermatology Physician in Virginia

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