Active NPI
Heather M Jackson, AA
- Anesthesiologist Assistant
- Savannah, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiologist Assistant
- License
- 005442
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 005442 | Other | GA | PA LICENSES |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
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
| License | State | Type | Specialty |
|---|---|---|---|
| 005442 | GA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Anesthesiology of North Carolina, PLLC | Current | Accepting new patients | |
| American Anesthesiology of North Carolina, PLLC | Current | Accepting new patients | |
| Fayetteville Anesthesia, P.a. | Current | 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.
-
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- Burlington, NC
- NPI 1053677195
-
- Anesthesiology Physician
- Fayetteville, NC
- NPI 1144362864
-
- Anesthesiology Physician
- Wilmington, NC
- NPI 1033412267
-
- Pain Medicine (Anesthesiology) Physician
- Wake Forest, NC
- NPI 1942248547
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.