Jennifer B Jackson, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

008275 Issued in NY

Practice address

1425 Portland Ave
Rochester, NY 14621-3001

Phone

(585) 922-4000

NPI assigned

Nov 6, 2006

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

Other names 1

• Jennifer Butler Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

96.62 of 100Reported as apm

Quality

74.51

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Newark Wayne Community Hospital

  • General Acute Care Hospital
  • Newark, NY
  • NPI 1770671182
  Medicare reassignment
• Rochester General Hospital

  • Family Medicine Physician
  • Rochester, NY
  • NPI 1356412712
  Medicare reassignment
• Newark Wayne Community Hospital

  • General Acute Care Hospital
  • Newark, NY
  • NPI 1346369212
  NPD
• Rochester General Hospital

  • General Acute Care Hospital
  • Rochester, NY
  • NPI 1255360517
  NPD

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290124800000",
    "number": "1578642823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 PORTLAND AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213001",
            "telephone_number": "585-922-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 PORTLAND AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213001",
            "telephone_number": "585-922-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JENNIFER",
        "middle_name": "B",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-06",
        "last_updated": "2010-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "008275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03217681",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "BUTLER",
            "credential": "P.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elena Jackson, MHC-P
• Elisha M Jackson, LPN
• Gerriann Jackson, CCC-SLP
• Indya Denise Jackson
• Jeanine Jackson, LPN
• Jessica Jackson
• Kayla M Jackson, LCAT, NCC
• Kinomi Sucara Jackson
• Korry Jackson
• Latasha Annette Jackson

• Physician Assistant in Rochester, NY
• Providers in Rochester, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2010; 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.