Peter Romney Jackson, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

042-0013818 Issued in VT

Practice address

1 S Prospect St
Burlington, VT 05401-3456

Phone

(802) 847-3333

NPI assigned

Jun 7, 2011

Last updated

Aug 1, 2024By the provider in NPPES

Sex

Male

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 NY, VT2 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

Psychiatry

Education

University of Utah School of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Vermont Medical Center IncGroup PAC ID 3779491071, 1,208 clinicians

Champlain Valley Physicians Hospital Medical CenterGroup PAC ID 2769396878, 356 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Univ. of Vermont - Fletcher Allen Health Care Hospital, Burlington, VT, CCN 470003
• The University of Vermont Health Network - Champl Hospital, Plattsburgh, NY, CCN 330250

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pjackson177584@direct.uvmhealth.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.

• University of Vermont Medical Center Inc

  dba Uvm Medical Center

  • Internal Medicine Physician
  • Burlington, VT
  • NPI 1659309615
  Medicare reassignment Care Compare group NPD
• Champlain Valley Physicians Hospital Medical Center

  • Internal Medicine Physician
  • Plattsburgh, NY
  • NPI 1124189782

  Psychiatry

  Medicare reassignment Care Compare group NPD
• Champlain Valley Physicians Hospital Medical Center

  • General Acute Care Hospital
  • Plattsburgh, NY
  • NPI 1033270699
  NPD (past)

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

• University of Vermont Medical Center Inc

  • General Acute Care Hospital
  • Burlington, VT
  • NPI 1568419976
  Care Compare affiliation
• Champlain Valley Physicians Hospital Medical Center

  • General Acute Care Hospital
  • Plattsburgh, NY
  • NPI 1033270699
  Care Compare affiliation

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

{
    "created_epoch": "1307404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1508150467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 BEEKMAN ST",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "12901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 S PROSPECT ST",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054013456",
            "telephone_number": "802-847-3333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "75 Beekman St",
            "address_purpose": "LOCATION",
            "city": "Plattsburgh",
            "state": "NY",
            "postal_code": "129011438",
            "country_code": "US",
            "telephone_number": "518-562-7790",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PETER",
        "middle_name": "ROMNEY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-07",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "290034",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VT",
            "license": "042-0013818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gabrielle Andrea Jacquet, MD
• Jade Mountain Wellness
• Jade Mountain Wellness, Inc.

• Psychiatry Physician in Burlington, VT
• Providers in Burlington, VT by specialty
• Psychiatry Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; 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.