Kimberly L Jackson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

248351 Issued in NY

Practice address

818 Ellicott St
Buffalo, NY 14203-1021

Phone

(716) 323-2000

Fax

(716) 323-0292

NPI assigned

Jun 26, 2008

Last updated

Mar 2, 2023By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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 1

Specialty

Pediatric Medicine

Education

State University of New York at Stony Brook, School of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kaleida HealthGroup PAC ID 7810805280, 214 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Kaleida Health

  dba Buffalo General Hospital

  • General Acute Care Hospital
  • Buffalo, NY
  • NPI 1639209596
  Medicare reassignment Care Compare group NPD
• University at Buffalo Pediatric Associates Inc

  • Pediatrics Physician
  • Buffalo, NY
  • NPI 1912928599
  Medicare reassignment NPD
• Kaleida Health

  dba Golisano Children's Hospital of Buffalo

  • General Acute Care Hospital
  • Buffalo, NY
  • NPI 1245365196
  NPD
• Kaleida Health

  dba Kaleida Health Outpatient Pharmacy

  • Community/Retail Pharmacy
  • Buffalo, NY
  • NPI 1992540546
  NPD
• University at Buffalo Pathologists, Inc

  • Anatomic Pathology & Clinical Pathology Physician
  • Williamsville, NY
  • NPI 1235155581
  NPD
• Kaleida Health

  dba Millard Fillmore Suburban Hospital

  • General Acute Care Hospital
  • Williamsville, NY
  • NPI 1053441907
  NPD (past)

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

{
    "created_epoch": "1214438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677715200000",
    "number": "1518129097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 MAIN ST FL 5",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031009",
            "telephone_number": "716-323-0034",
            "fax_number": "716-323-0292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 ELLICOTT ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142031021",
            "telephone_number": "716-323-2000",
            "fax_number": "716-323-0292"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1540 Maple Rd",
            "address_purpose": "LOCATION",
            "city": "Williamsville",
            "state": "NY",
            "postal_code": "142213647",
            "country_code": "US",
            "telephone_number": "716-568-3600",
            "fax_number": "716-323-0292",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KIMBERLY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-26",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "248351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03040719",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joanna Jackson
• Jordanei Rebecca Jackson
• Kathleen Jackson
• Kelley R Jackson, LPN
• Keyna Jackson
• Kimmerly Jackson, FNP
• Laurletha Renay Jackson
• Melissa Rae Jackson
• Natasha Jackson
• Patricia Jackson, CRNA

• Pediatrics Physician in Buffalo, NY
• Providers in Buffalo, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2023; 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.