Individual provider Active NPI

Heather M Jackson, AA

  • Anesthesiologist Assistant
  • Savannah, GA
National Provider Identifier
1629220017
Registry record updated Jun 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
005442 Issued in GA
Practice address
11705 Mercy Blvd
Savannah, GA 31419-1711
Phone
(912) 819-6000
NPI assigned
Oct 16, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X 005442 GA Primary

Addresses

Primary practice location

11705 Mercy Blvd
Savannah, GA 31419-1711

Mailing address

6605 Abercorn St
Suite 108
Savannah, GA 31405-5815
Phone (912) 354-5357

Other identifiers 1

IdentifierTypeStateIssuer
005442OtherGAPA LICENSES

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161115000783 NC Practitioner - Anesthesiology Assistant 7113086851 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1781 Metromedical Dr
Fayetteville, NC 28304-3862
Phone (910) 323-1647

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

State licenses

LicenseStateTypeSpecialty
005442GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
American Anesthesiology of North Carolina, PLLC CurrentSince Apr 1, 2025 Accepting new patients
American Anesthesiology of North Carolina, PLLC CurrentSince Apr 1, 2025 Accepting new patients
Fayetteville Anesthesia, P.a. CurrentSince Oct 17, 2016 Accepting new patients
American Anesthesiology of North Carolina, PLLC Past Accepting new patients

Locations

1781 Metromedical Dr
Fayetteville, NC 28304
Phone (828) 771-5227

3100 Spring Forest Rd
Ste 130
Raleigh, NC 27616
Phone (919) 882-0705

4420 Lake Boone Trl
Raleigh, NC 27607
Phone (919) 784-3034

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245110400000",
    "number": "1629220017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6605 ABERCORN ST",
            "address_2": "SUITE 108",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314055815",
            "telephone_number": "912-354-5357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11705 MERCY BLVD",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314191711",
            "telephone_number": "912-819-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "HEATHER",
        "middle_name": "M",
        "credential": "AA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-16",
        "last_updated": "2009-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "GA",
            "license": "005442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSES",
            "identifier": "005442",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.