NPIMap

Individual provider Active NPI

Timothy L Jackson, MD

  • Internal Medicine Physician
  • Beaver, PA
National Provider Identifier
1427070747
Registry record updated Sep 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD044713L Issued in PA
Practice address
500 Sharon Rd
Beaver, PA 15009-1957
Phone
(724) 728-8751
Fax
(724) 728-4633
NPI assigned
Jul 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD044713L PA Primary
Internal Medicine Physician 207R00000X 35-063422 OH

Addresses

Primary practice location

500 Sharon Rd
Beaver, PA 15009-1957

Mailing address

500 Sharon Rd
Beaver, PA 15009-1957
Phone (724) 728-8751

Other identifiers 1

IdentifierTypeStateIssuer
0012616830002MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100503000465 PA Practitioner - Internal Medicine 7214955400 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Hahnemann University College of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Heritage Valley Multispecialty Group IncGroup PAC ID 0042105678, 229 clinicians
Mrs Physical TherapyGroup PAC ID 0042128407, 168 clinicians

Practice addresses (Care Compare)

1 Peartree Way
Beaver, PA 15009-1954
Phone (724) 773-8960

2 Peartree Way
Credentialing and Enrollment
Beaver, PA 15009-1954

4538 Peach St
Erie, PA 16509-1364
Phone (814) 864-6650

500 Sharon Rd
Beaver, PA 15009-1957
Phone (724) 728-8751

Hospital & facility affiliations

  • Advanced Home Health Home health agency, Pittsburgh, PA, CCN 397759
  • Gallagher Home Health Services Home health agency, Bridgeville, PA, CCN 398024
  • Concordia Visiting Nurses Home health agency, Cabot, PA, CCN 397717
  • Advanced Hospice, LLC Hospice, Pittsburgh, PA, CCN 391798
  • Heritage Valley Beaver Hospital, Beaver, PA, CCN 390036
  • Heritage Valley Sewickley Hospital, Sewickley, PA, CCN 390037
  • Magee Womens Hospital of Upmc Health System Hospital, Pittsburgh, PA, CCN 390114

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35-063422OHMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Heritage Valley Multispecialty Group, Inc. Internal Medicine CurrentSince Oct 19, 1991 Accepting new patients
Heritage Valley Multispecialty Group, Inc. Internal Medicine CurrentSince Oct 19, 1991 Accepting new patients
Heritage Valley Medical Group, Inc. Past Accepting new patients

Locations

200 Ohio River Blvd
Baden, PA 15005

500 Sharon Rd
Beaver, PA 15009
Phone (724) 728-7683

2 Peartree Way
Beaver, PA 15009
Phone (724) 773-6802

Interoperability endpoints

  • Direct secure messaging: timothyjackson@hvhs.allscriptsdirect.net

Organizations & group practices 4

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.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442361600000",
    "number": "1427070747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 SHARON RD",
            "city": "BEAVER",
            "state": "PA",
            "postal_code": "150091957",
            "telephone_number": "724-728-8751",
            "fax_number": "724-728-4633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SHARON RD",
            "city": "BEAVER",
            "state": "PA",
            "postal_code": "150091957",
            "telephone_number": "724-728-8751",
            "fax_number": "724-728-4633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TIMOTHY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2015-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD044713L",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-063422",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012616830002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaver, PA

Sources for this page

Verify at the official NPI Registry.