Peter Jackson, M.D.

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

MD170303 Issued in OR

Practice address

2222 NW Lovejoy St
#411
Portland, OR 97210-3033

Phone

(503) 413-5702

Fax

(503) 413-6499

NPI assigned

Apr 5, 2011

Last updated

May 12, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 VA

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

Pulmonary DiseaseAlso: Internal Medicine

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MCV Associated PhysiciansGroup PAC ID 4385542117, 1,779 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Medical College of Virginia Hospitals Hospital, Richmond, VA, CCN 490032
• Vcu Health Tappahannock Hospital Hospital, Tappahannock, VA, CCN 490084

Merit-based Incentive Payment System (MIPS)

Final score

83.95 of 100Reported as group

Quality

69.91

Promoting interoperability

99

Improvement activities

40

Cost

77.42

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• MCV Associated Physicians

  dba MCV Physicians

  • Anesthesiology Physician
  • Richmond, VA
  • NPI 1710959457
  Medicare reassignment Care Compare group NPD

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

• Vcu Health Tappahannock Hospital

  • General Acute Care Hospital
  • Tappahannock, VA
  • NPI 1760580757
  Care Compare affiliation
• Virginia Commonwealth University Health System Authority

  dba Medical College of Virginia Hospitals

  • General Acute Care Hospital
  • Richmond, VA
  • NPI 1013091727
  Care Compare affiliation
• Virginia Commonwealth University Health System Authority

  dba VCU Medical Center

  • General Acute Care Hospital
  • Richmond, VA
  • NPI 1437175734
  Care Compare affiliation

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

{
    "created_epoch": "1301961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494547200000",
    "number": "1598054132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 NW LOVEJOY ST",
            "address_2": "#411",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103033",
            "telephone_number": "503-413-5702",
            "fax_number": "503-413-6499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 NW LOVEJOY ST",
            "address_2": "#411",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103033",
            "telephone_number": "503-413-5702",
            "fax_number": "503-413-6499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PETER",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-04-05",
        "last_updated": "2017-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "OR",
            "license": "MD170303",
            "primary": true
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "OR",
            "license": "MD170303",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Jackson, M.S., OTR/L
• Natalie Jo Jackson
• Natasha Marie Jackson
• Nicole Jackson
• Patricia Louise Jackson, RN
• Rachael Alexis Jackson, MS, MSW, LCSW
• Rachel K Jackson, MD
• Rachel M. Jackson, BEHAVIOR ANALYST
• Raymond Thomas Jackson
• Robin Naumann Jackson, CCC-SLP

• Pulmonary Disease Physician in Portland, OR
• Providers in Portland, OR by specialty
• Pulmonary Disease Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2017; 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.