David B. Jackson, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

42186-020 Issued in WI

Practice address

6308 8TH Ave
Kenosha, WI 53143-5031

Phone

(262) 656-2011

NPI assigned

Nov 29, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WI

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

Anesthesiology

Education

Wake Forest University School of Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Great Lakes Anesthesia and Pain Specialists SCGroup PAC ID 2365598406, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Midwest Orthopedic Specialty Hospital Hospital, Franklin, WI, CCN 520205

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Great Lakes Anesthesia and Pain Specialists SC

  • Anesthesiology Physician
  • Franklin, WI
  • NPI 1720218647
  Medicare reassignment Care Compare group NPD
• Brookfield Anesthesiologists, S.C.

  • Anesthesiology Physician
  • Brookfield, WI
  • NPI 1942257902
  Medicare reassignment NPD
• David B. Jackson, M.D., S.C.

  • Pain Medicine (Anesthesiology) Physician
  • Kenosha, WI
  • NPI 1528015120
  NPD (past) Authorized official
• Midwest Physicians Anesthesia Service, SC

  • Pain Medicine (Anesthesiology) Physician
  • Kenosha, WI
  • NPI 1275586653
  NPD
• Chad Novasic PT LTD

  • Physical Therapist
  • Racine, WI
  • NPI 1578679890
  NPD (past)

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

• Midwest Orthopedic Specialty Hospital, LLC

  • Special Hospital
  • Franklin, WI
  • NPI 1861635971
  Care Compare affiliation

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

{
    "created_epoch": "1133222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234656000000",
    "number": "1477536928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 S EXECUTIVE DR",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530054266",
            "telephone_number": "262-787-4026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6308 8TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531435031",
            "telephone_number": "262-656-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DAVID",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-29",
        "last_updated": "2009-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WI",
            "license": "42186-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "050087011",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33333500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mehran Jabbarzadeh, MD
• Micelle Lynn Jabczynski, M.S. CCC-SLP
• Jenell Diane Jackley, CPNP
• Christopher D. Jackson, LPC
• Danielle Marie Jackson, LPC
• Glenda Elizabeth Jackson, R.N.
• Leeann G Jackson, LPC
• Nyles Antony Jackson, MSW, APSW, SAC-IT
• Michael A Jacobs, PA-C
• Amy Lynn Jacobson, P.T.

• Anesthesiology Physician in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Anesthesiology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2009; 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.