Active NPI
Maisie Lee Jackson, MD
- Anesthesiology Physician
- Philadelphia, PA
National Provider Identifier
1477845493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- MD454490
- Practice address
- 3400 Spruce St
Philadelphia, PA 19104-4206 - Phone
- (215) 662-9664
- NPI assigned
- May 10, 2011
- Last updated
- Sep 16, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | MD454490 | PA | Primary |
Addresses
Primary practice location
3400 Spruce St
Philadelphia, PA 19104-4206
Mailing address
3400 Spruce St
Philadelphia, PA 19104-4206
Phone (215) 662-9664
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD454490 | PA | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442361600000",
"number": "1477845493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 SPRUCE ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044206",
"telephone_number": "215-662-9664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 SPRUCE ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044206",
"telephone_number": "215-662-9664"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MAISIE",
"middle_name": "LEE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-10",
"last_updated": "2015-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "PA",
"license": "MD454490",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.