Carol Mackenzie Jackson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA052046 Issued in PA

Practice address

333 Cottman Ave
Philadelphia, PA 19111-2434

Phone

(215) 728-6900

Fax

(215) 728-2773

NPI assigned

May 16, 2007

Sex

Female

Sole proprietor

No

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 PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Temple Faculty Practice Plan IncGroup PAC ID 0345588711, 1,325 clinicians

St Lukes Physician Group IncGroup PAC ID 6709798333, 2,161 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Lukes Hospital Hospital, Bethlehem, PA, CCN 390049
• Hospital of the Fox Chase Cancer Center Hospital, Philadelphia, PA, CCN 390196

Merit-based Incentive Payment System (MIPS)

Final score

81.21 of 100Reported as group

Quality

49.71

Promoting interoperability

100

Improvement activities

40

Cost

74.23

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• St. Luke'S Physician Group, Inc.

  • Family Medicine Physician
  • Bethlehem, PA
  • NPI 1700984622
  Medicare reassignment Care Compare group
• Temple Faculty Practice Plan Inc

  • Anesthesiology Physician
  • Philadelphia, PA
  • NPI 1881176949
  Medicare reassignment Care Compare group
• Temple Faculty Practice Plan, Inc

  • Emergency Medicine Physician
  • Philadelphia, PA
  • NPI 1639651672
  NPD
• Temple Faculty Practice Plan Inc

  • Urology Physician
  • Voorhees, NJ
  • NPI 1407638794
  NPD
• Health Access Network

  • Physical Medicine & Rehabilitation Physician
  • Chester, PA
  • NPI 1356460380
  NPD (past)

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

• American Oncologic Hospital

  • Special Hospital
  • Philadelphia, PA
  • NPI 1730195017
  Care Compare affiliation
• St Luke'S Hospital

  • General Acute Care Hospital
  • Allentown, PA
  • NPI 1366011413
  Care Compare affiliation
• St Luke'S Hospital

  • General Acute Care Hospital
  • Easton, PA
  • NPI 1376339226
  Care Compare affiliation
• St Luke'S Hospital

  • General Acute Care Hospital
  • Lehighton, PA
  • NPI 1528737988
  Care Compare affiliation
• St Lukes Hospital

  • General Acute Care Hospital
  • Bethlehem, PA
  • NPI 1013933175
  Care Compare affiliation
• St. Luke'S Hospital

  • General Acute Care Hospital
  • Allentown, PA
  • NPI 1548293954
  Care Compare affiliation
• St. Luke'S Hospital Bethlehem

  • Adult Mental Health Clinic/Center
  • Lehighton, PA
  • NPI 1962094920

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669852800000",
    "number": "1457567265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 N. BROAD ST. ROOM 001A",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191404106",
            "telephone_number": "215-926-9022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 COTTMAN AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191112434",
            "telephone_number": "215-728-6900",
            "fax_number": "215-728-2773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CAROL",
        "middle_name": "MACKENZIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-16",
        "last_updated": "2022-12-01",
        "certification_date": "2022-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA052046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Jackson
• Ateeya Jackson, NURSE PRACTITIONER
• Bertha Adele Jackson, CRNP
• Biancha Jackson, MHSC, RD
• Cameron Lauren Jackson
• Chante L Jackson
• Cheri Lynn Jackson
• Cheryl A Jackson, M.D.
• Christina Jackson, M.D.
• Cody Boyer Jackson, MD, PHD

• Physician Assistant in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2022; 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.