Tracy Jackson

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

1038809410001 Issued in PA

Practice address

151 Knock Hill Dr
Royersford, PA 19468-3493

Phone

(484) 213-5437

NPI assigned

Jun 14, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1623628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1497323695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 KNOCK HILL DR",
            "city": "ROYERSFORD",
            "state": "PA",
            "postal_code": "194683493",
            "telephone_number": "484-213-5437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 KNOCK HILL DR",
            "city": "ROYERSFORD",
            "state": "PA",
            "postal_code": "194683493",
            "telephone_number": "484-213-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TRACY",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-14",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "PA",
            "license": "1038809410001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES",
            "identifier": "1038809410001",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tjackson@trajavahomehealth.com",
            "affiliation": "N",
            "endpointDescription": "tjackson@trajavahomehealth.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "151 Knock Hill Dr",
            "city": "Royersford",
            "state": "PA",
            "country_code": "US",
            "postal_code": "194683493",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Infusion Center of Pennsylvania LLC
• Integrated Medical Group, P.C.
• Kathleen Mary Inverso, RPH
• J & J Medical, Inc.
• J.C. Family Services Limited Liability Company
• Kelly Ann Jeffery, DPT
• Kelsey Yvonne Jehl, PT, DPT
• Jericho Homecare, LLC
• John J Aylward MD PC
• Silpa Kadiyala, D.M.D

• Home Health Agency in Royersford, PA
• Providers in Royersford, PA by specialty
• Home Health Agency in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.