Elizabeth Michele Jackson, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

51246 Issued in TN

Practice address

444 Clinchfield St
Suite 2900
Kingsport, TN 37660-3606

Phone

(423) 245-6101

Fax

(423) 245-2396

NPI assigned

Jun 5, 2009

Sex

Female

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 TN

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

General Surgery

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellmont Medical Associates IncGroup PAC ID 8123291739, 432 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellmont Holston Valley Medical Center Hospital, Kingsport, TN, CCN 440017
• Indian Path Community Hospital Hospital, Kingsport, TN, CCN 440176
• Lonesome Pine Hospital Hospital, Big Stone Gap, VA, CCN 490114
• Johnson City Medical Center Hospital, Johnson City, TN, CCN 440063

Procedures performed for Medicare patients

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.

• Wellmont Medical Associates Inc

  • Pulmonary Disease Physician
  • Kingsport, TN
  • NPI 1780986257

  Surgery

  Medicare reassignment Care Compare group NPD
• Wellmont Medical Associates, Inc.

  • Psychiatry Physician
  • Johnson City, TN
  • NPI 1275393522
  NPD

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

• Mountain States Health Alliance

  • Psychiatric Hospital Unit
  • Johnson City, TN
  • NPI 1023434339
  Care Compare affiliation
• Mountain States Health Alliance

  • Psychiatric Hospital Unit
  • Johnson City, TN
  • NPI 1962915652
  Care Compare affiliation
• Mountain States Health Alliance

  • General Acute Care Hospital
  • Johnson City, TN
  • NPI 1972606465
  Care Compare affiliation
• Mountain States Health Alliance

  • General Acute Care Hospital
  • Kingsport, TN
  • NPI 1992813240
  Care Compare affiliation
• Wellmont Health System

  • General Acute Care Hospital
  • Kingsport, TN
  • NPI 1487690400
  Care Compare affiliation
• Wellmont Health System

  • General Acute Care Hospital
  • Big Stone Gap, VA
  • NPI 1801826912
  Care Compare affiliation

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

{
    "created_epoch": "1244160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417392000000",
    "number": "1386870285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3044 HIGHLAND GROVE DR",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376154596",
            "telephone_number": "423-483-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 CLINCHFIELD ST",
            "address_2": "SUITE 2900",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603606",
            "telephone_number": "423-245-6101",
            "fax_number": "423-245-2396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ELIZABETH",
        "middle_name": "MICHELE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-05",
        "last_updated": "2014-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "51246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Genesia Dickson Irick, FNP
• Michael Itidiare, D.O., M.B.S
• Itl Pharma
• Amanda R. Jackson, NP
• Brian Jackson
• Kelly Nicole Jackson, FNP
• Zachary Lynn Jackson
• Rekha Jain, M.D.
• Elizabeth Graceanne James, MS
• Nelson James, RN

• Surgery Physician in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Surgery Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2014; 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.