Alfred Vaughn Derise Jackson Jr., MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

50821 Issued in TN

Practice address

930 Adell Ree Park LN
Knoxville, TN 37909-2543

Phone

(865) 769-2600

NPI assigned

Jul 19, 2010

Sex

Male

Sole proprietor

No

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.

• Emergency Coverage, LLC

  • Family Medicine Physician
  • Newport, TN
  • NPI 1427005008

  TN

  Medicare reassignment Care Compare group
• Westbrook Medical Center, PLLC

  • Family Medicine Physician
  • Knoxville, TN
  • NPI 1598893166

  Family Medicine, TN

  Medicare reassignment NPD
• Southeastern Emergency Physicians LLC

  • Emergency Medicine Physician
  • Maysville, KY
  • NPI 1356379382

  Emergency Medicine, TN

  Medicare reassignment NPD

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

• Claiborne Medical Center

  • General Acute Care Hospital
  • Tazewell, TN
  • NPI 1942205166

  Hospital

  Care Compare affiliation
• Roane County Medical Center

  • General Acute Care Hospital
  • Harriman, TN
  • NPI 1700036696

  Hospital

  Care Compare affiliation

Specialty

Family Practice

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Coverage LLC 761 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Claiborne Medical Center Hospital, Tazewell, TN, CCN 440057
• Roane Medical Center Hospital, Harriman, TN, CCN 440031

Medicare fee-for-service enrollment

Enrolled in TN

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ajacks12@yourcarecommunity.org

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 23, 2023.

{
    "created_epoch": "1279497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679529600000",
    "number": "1609189695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 ADELL REE PARK LN",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379092543",
            "telephone_number": "865-769-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 ADELL REE PARK LN",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379092543",
            "telephone_number": "865-769-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ALFRED",
        "middle_name": "VAUGHN DERISE",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-19",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "50821",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "50821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J&R Transportation
• Jack Scariano Jr MD PLLC
• Jack W. Haney, D.D.S., P.C.
• Megan C Jack, MD
• Mycah Jack, FNP-BC
• Becky L Jackson, MD
• Brittany Michelle Jackson
• Carla L Jackson, LCSW
• Diamond Alyssia Jackson, LPN
• Elijah Jackson

• All providers in Knoxville, TN
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.