Joseph Alexander Jackson IV, D.O.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

217374 Issued in MA

Practice address

1493 Cambridge St
Station Landing/Ccad
Cambridge, MA 02139-1047

Phone

(781) 306-8655

Fax

(781) 306-8655

NPI assigned

Jan 28, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Dr. Joseph A Jackson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Osteopathy

Practice roles

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.

• Bournewood Clinical Associates

  • Nurse Practitioner
  • Brookline, MA
  • NPI 1891780144

  Psychiatry

  NPD (past)
• First Psychiatric Planners, Inc

  • Psychiatric Hospital
  • Brookline, MA
  • NPI 1093714412
  NPD (past)

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

{
    "created_epoch": "1138406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1609847631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1493 CAMBRIDGE ST",
            "address_2": "STATION LANDING/CCAD",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021391047",
            "telephone_number": "781-306-8655",
            "fax_number": "781-306-8655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1493 CAMBRIDGE ST",
            "address_2": "STATION LANDING/CCAD",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021391047",
            "telephone_number": "781-306-8655",
            "fax_number": "781-306-8655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JOSEPH",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-28",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "217374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER",
            "identifier": "J26769",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2020203",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOSEPH",
            "last_name": "JACKSON",
            "middle_name": "A",
            "prefix": "DR.",
            "credential": "D.O.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Lotachi Izuchi
• Zainab Susan Jabur, MD, MPH
• Joanne S Jack, FNP
• Shawn Jackson Dupuy, D.C.
• Doris A Jackson, PHD
• Kathryn Alice Jackson, PH.D.
• Latoya Shari Jackson, M.D.
• Maggie Virginia Jackson, MSW
• Rose M Jacob, RN
• Irene A. Jacobs, PHD

• Psychiatry Physician in Cambridge, MA
• Providers in Cambridge, MA by specialty
• Psychiatry Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.