Pamela Lee Jackson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

42-0008559 Issued in VT

Practice address

353 Blair Park Rd
Williston, VT 05495-7530

Phone

(802) 847-1440

Fax

(802) 847-3014

NPI assigned

Jun 28, 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 2

Medicare fee-for-service enrollment

Enrolled in VT

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)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pjackson3787@direct.uvmhealth.org

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.

• University of Vermont Medical Center Inc

  • Internal Medicine Physician
  • Burlington, VT
  • NPI 1659309615

  Pediatrics, VT

  Medicare reassignment NPD

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420675200000",
    "number": "1619905072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 HARBOR RIDGE RD",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037849",
            "telephone_number": "802-863-8962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 BLAIR PARK RD",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054957530",
            "telephone_number": "802-847-1440",
            "fax_number": "802-847-3014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PAMELA",
        "middle_name": "LEE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2015-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VT",
            "license": "42-0008559",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OVN0393",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "E01148865",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ini PC
• Inspired Woodman Health & Human Services Institute
• Interventional Spine of Vermont, PLLC
• Ivan Tomek MD PLLC
• Courtney Lynn Iverson, DPT
• Kramer Jakubek, PT, DPT, CSCS
• Jacqueline Jancaitis, DPT
• Callan Janowiec, FNP
• Adrienne Jarvis, MD
• Danielle Jasinski

• All providers in Williston, VT
• Pediatrics Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.