Kavita Srivastava Jackson, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

D0086968 Issued in MD

Practice address

1500 Forest Glen Rd Dept of
Silver Spring, MD 20910-1460

Phone

(301) 754-7000

NPI assigned

Jun 12, 2015

Last updated

Jun 19, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in DC, ME2 enrollments

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 2

Specialty

Emergency Medicine

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Holy Cross Hospital Hospital, Silver Spring, MD, CCN 210004
• Holy Cross Germantown Hospital Hospital, Germantown, MD, CCN 210065

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kjackson1102607@direct.umm.edu
• Direct secure messaging: kjackson1264849@direct.trinity-health.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mep Health, LLC

  • Emergency Medicine Physician
  • Rockville, MD
  • NPI 1164483558

  DC

  Medicare reassignment NPD
• Cep America LLC

  dba Vituity

  • Emergency Medicine Physician
  • Washington, DC
  • NPI 1073914396
  Medicare reassignment NPD
• Emergency Medicine Associates P.a., P.C.

  • Emergency Medicine Physician
  • Falls Church, VA
  • NPI 1134117393

  DC

  Medicare reassignment NPD
• Pine Tree Urgent Care LLC

  • Urgent Care Clinic/Center
  • Bangor, ME
  • NPI 1679450969
  Medicare reassignment NPD
• Cep America LLC

  • Emergency Medicine Physician
  • Silver Spring, MD
  • NPI 1851286041
  NPD
• Emergency Medicine Associates, PA

  • Emergency Medicine Physician
  • Largo, MD
  • NPI 1861243818
  NPD
• Cep America LLC

  • Emergency Medicine Physician
  • Fort Lauderdale, FL
  • NPI 1700747946
  NPD
• Dirigo Counseling Clinic, LLC

  • Community/Behavioral Health Agency
  • Bangor, ME
  • NPI 1295734085
  NPD
• Emergency Medicine Associates P.a., P.C.

  • Internal Medicine Physician
  • Culpeper, VA
  • NPI 1881559102
  NPD

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

• Holy Cross Health, Inc

  dba Holy Cross Hospital

  • General Acute Care Hospital
  • Silver Spring, MD
  • NPI 1669417838
  Care Compare affiliation
• Holy Cross Health, Inc.

  dba Holy Cross Germantown Hospital

  • General Acute Care Hospital
  • Germantown, MD
  • NPI 1245655638
  Care Compare affiliation
• Holy Cross Health, Inc.

  dba Holy Cross Health Lab Outreach

  • Clinical Medical Laboratory
  • Silver Spring, MD
  • NPI 1831574284

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1434067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560902400000",
    "number": "1497136600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 FOREST GLEN RD",
            "address_2": "DEPT OF EMERGENCY MEDICINE",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209101484",
            "telephone_number": "301-754-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 FOREST GLEN RD DEPT OF",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209101460",
            "telephone_number": "301-754-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5501 Old York Rd",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191413018",
            "country_code": "US",
            "telephone_number": "215-456-3834",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KAVITA",
        "middle_name": "SRIVASTAVA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-12",
        "last_updated": "2019-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "MT209033",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MD",
            "license": "D0086968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah Anthony Jack, MD
• Bernaiyya Jackson
• Celitta Ann Jackson, LCPC
• Janardia Jackson
• Jazmine Jackson
• Kirsten Jackson
• Letta M Jackson, RN
• Michelle Jackson
• Rhonda Jackson, TEACHER
• Ricky M Jackson, LCSW-C

• Emergency Medicine Physician in Silver Spring, MD
• Providers in Silver Spring, MD by specialty
• Emergency Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2019; 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.