NPIMap

Individual provider Active NPI

Cory Daniel Jackson

  • Interventional Cardiology Physician
  • Wilmington, NC
National Provider Identifier
1609365170
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
321188 Issued in NC
Practice address
1415 Physicians Dr
Wilmington, NC 28401-7338
Phone
(518) 859-5714
NPI assigned
May 9, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X 321188 NC Primary

Addresses

Primary practice location

1415 Physicians Dr
Wilmington, NC 28401-7338

Mailing address

1415 Physicians Dr
Wilmington, NC 28401-7338
Phone (518) 859-5714

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220310002035 SC Practitioner - Internal Medicine 4587910526 Reassigns benefits to 1 organization
I20241212003059 NC Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology) 4587910526 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
University of Florida College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1415 Physicians Dr
Wilmington, NC 28401-7338
Phone (910) 662-9500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting56

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
321188NCMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pender Memorial Hospital, Incorporated CurrentSince Aug 1, 2025 Accepting new patients
Novant Health New Hanover Regional Medical Center LLC CurrentSince Aug 1, 2025 Accepting new patients
NMG Health Services LLC CurrentSince Jul 1, 2025 Accepting new patients
24 On Physicians of SC, LLC CurrentSince Feb 15, 2022 Accepting new patients
Novant Health Medical Group Coastal Region, LLC CurrentSince Jul 1, 2025 Accepting new patients
Brunswick Community Hospital, LLC CurrentSince Aug 1, 2025 Accepting new patients
Novant Health New Hanover Regional Medical Center LLC CurrentSince Aug 1, 2025 Accepting new patients
The Moses H Cone Memorial Hospital Operating Corporation CurrentSince Sep 2, 2024 Accepting new patients
The Moses H. Cone Memorial Hospital Operating Corporation CurrentSince Sep 2, 2024 Accepting new patients
Pender Memorial Hospital Incorporated CurrentSince Aug 1, 2025 Accepting new patients
New Hanover Medical Group PA Past Accepting new patients

Locations

257 Hospital Dr NE
Ste 201
Bolivia, NC 28422

240 Hospital Dr NE
Bolivia, NC 28422
Phone (336) 399-7678

507 E Fremont St
Burgaw, NC 28425
Phone (910) 259-5451

509 N Elam Ave
Fl 3
Greensboro, NC 27403
Phone (336) 832-1970

1200 N Elm St
Greensboro, NC 27401
Phone (336) 574-7000

2400 W Friendly Ave
Greensboro, NC 27403
Phone (336) 832-1100

800 Jefferson St
Ste 112
Whiteville, NC 28472
Phone (910) 642-8164

1415 Physicians Dr
Wilmington, NC 28401
Phone (910) 251-3766

105 Scotts Hill Medical Dr
Wilmington, NC 28411
Phone (910) 686-2840

316 Calhoun St
Charleston, SC 29401
Phone (843) 724-2000

Interoperability endpoints

  • Direct secure messaging: cjackson1701655@direct.novanthealth.org

Organizations & group practices 11

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1525824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1609365170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 PHYSICIANS DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017338",
            "telephone_number": "518-859-5714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 PHYSICIANS DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017338",
            "telephone_number": "518-859-5714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CORY",
        "middle_name": "DANIEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-09",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NC",
            "license": "321188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.