Derrick O'Neal Jackson, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

36003456 Issued in OH

Practice address

420 Oak Hill Avenue
Youngstown, OH 44502-1415

Phone

(330) 870-3900

Fax

(330) 870-3901

NPI assigned

Apr 9, 2007

Last updated

Apr 5, 2022By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Gentle Footcare LLC

  • Foot & Ankle Surgery Podiatrist
  • Columbus, OH
  • NPI 1710999792
  Medicare reassignment NPD
• Lake County Foot & Ankle Associates, LLC

  dba Foot & Ankle Specialists of Ohio, LLC

  • Foot & Ankle Surgery Podiatrist
  • Mentor, OH
  • NPI 1770605347
  Medicare reassignment NPD
• Gentle Footcare LLC

  • Durable Medical Equipment & Medical Supplies
  • Worthington, OH
  • NPI 1992406490
  NPD
• Lake County Foot & Ankle Associates, LLC

  • Foot & Ankle Surgery Podiatrist
  • Wadsworth, OH
  • NPI 1154128064
  NPD
• Asian Services in Action, Inc

  dba International Community Health Center- Akron

  • Federally Qualified Health Center (FQHC)
  • Akron, OH
  • NPI 1306298195
  NPD (past)
• Asian Services in Action, Inc

  dba International Community Health Center- Cleveland

  • Federally Qualified Health Center (FQHC)
  • Cleveland, OH
  • NPI 1386286011
  NPD (past)

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1518080811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3255 E LIVINGSTON AVENUE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432271967",
            "telephone_number": "866-953-3519",
            "fax_number": "614-239-1080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 OAK HILL AVENUE",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445021415",
            "telephone_number": "330-870-3900",
            "fax_number": "330-870-3901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DERRICK",
        "middle_name": "O'NEAL",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-09",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OH",
            "license": "30003456",
            "primary": false
        },
        {
            "code": "213ER0200X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Radiology",
            "state": "OH",
            "license": "36003456",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OH",
            "license": "36003456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cazhia Jackson
• Cherelle Lavett Jackson
• Clarence A Jackson
• David Jackson, M.D.
• Deborah Jackson
• Jacob G Jackson
• Jacqueline Jackson
• Janet Rose Jackson, R.N.
• Karleena Michele Jackson, ASSOC.
• Kathryn M Jackson

• Foot & Ankle Surgery Podiatrist in Youngstown, OH
• Providers in Youngstown, OH by specialty
• Foot & Ankle Surgery Podiatrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.