Active NPI
Alfred B Jackson III, PA-C, MBA
- Surgical Physician Assistant
- Wilmington, DE
National Provider Identifier
1417078908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- C5-0000216
- Practice address
- 501 W 14TH St
Suite 4154
Wilmington, DE 19801-1013 - Phone
- (302) 428-4654
- NPI assigned
- Apr 2, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | C5-0000216 | DE | Primary |
Addresses
Primary practice location
501 W 14TH St
Suite 4154
Wilmington, DE 19801-1013
Mailing address
797 Slate Hill Dr
Oxford, PA 19363-1833
Phone (610) 932-7007
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Business Administration, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C5-0000216 | DE | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Patrick Swier MD PA | Surgical | Past | Accepting new patients |
| Upper Chesapeake Surgical Associates, LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Surgery Physician
- Bel Air, MD
- NPI 1629175997
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270512000000",
"number": "1417078908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "797 SLATE HILL DR",
"city": "OXFORD",
"state": "PA",
"postal_code": "193631833",
"telephone_number": "610-932-7007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 W 14TH ST",
"address_2": "SUITE 4154",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198011013",
"telephone_number": "302-428-4654"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "ALFRED",
"middle_name": "B",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "PA-C, MBA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-02",
"last_updated": "2010-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "DE",
"license": "C5-0000216",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.