Active NPI
Debra Lynn Jackson, PH.D.
- Psychologist
- Eugene, OR
National Provider Identifier
1477769651
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1221
- Practice address
- 1892 Willamette St
Eugene, OR 97401-4404 - Phone
- (541) 465-1885
- Fax
- (541) 344-4620
- NPI assigned
- May 15, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1221 | OR | Primary |
Addresses
Primary practice location
1892 Willamette St
Eugene, OR 97401-4404
Mailing address
1892 Willamette St
Eugene, OR 97401-3383
Phone (541) 465-1885
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1221 | Other | OR | STATE LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090527000587 | OR | Practitioner - Clinical Psychologist | 0345399127 | Practice locations: Eugene, OR |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1892 Willamette St
Dr Debra Jackson and Associates
Eugene, OR 97401-4044
Phone (541) 465-1885
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1221 | OR | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228867200000",
"number": "1477769651",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1892 WILLAMETTE ST",
"city": "EUGENE",
"state": "OR",
"postal_code": "974013383",
"telephone_number": "541-465-1885",
"fax_number": "541-344-4620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1892 WILLAMETTE ST",
"city": "EUGENE",
"state": "OR",
"postal_code": "974014404",
"telephone_number": "541-465-1885",
"fax_number": "541-344-4620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DEBRA",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-15",
"last_updated": "2008-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OR",
"license": "1221",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "1221",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2008; 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.