Patrick Jackson

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

2016-00882 Issued in NC

Practice address

1000 Blythe Blvd
Charlotte, NC 28203-5812

Phone

(704) 355-2171

NPI assigned

May 16, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC, AL, FL3 enrollments

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 3

Specialty

Emergency Medicine

Education

University of South Carolina School of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency Medicine Services of FL LLCGroup PAC ID 8426413931, 686 clinicians

Sound Physicians Emergency Medicine of South Carolina LLCGroup PAC ID 2163702739, 48 clinicians

Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida Brandon Hospital Hospital, Brandon, FL, CCN 100243
• HCA Florida South Tampa Hospital Hospital, Tampa, FL, CCN 100206
• HCA Florida Sarasota Doctors Hospital Hospital, Sarasota, FL, CCN 100166
• Musc Medical Center Hospital, Charleston, SC, CCN 420004

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pjackson510859@direct.musc.edu

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.

• Emergency Medicine Services of FL, LLC

  • Emergency Medicine Physician
  • Aventura, FL
  • NPI 1043917180
  Medicare reassignment Care Compare group NPD
• Sound Physicians Emergency Medicine of South Carolina LLC

  • Emergency Medicine Physician
  • Aiken, SC
  • NPI 1730636168
  Medicare reassignment Care Compare group NPD
• Musc Community Physicians

  • Internal Medicine Physician
  • Bamberg, SC
  • NPI 1841878006
  Medicare reassignment Care Compare group
• App of South Carolina Ed PLLC

  • Emergency Medicine Physician
  • Hartsville, SC
  • NPI 1457878084
  Medicare reassignment NPD
• Emergency Services of Montgomery PC

  • Emergency Medicine Physician
  • Prattville, AL
  • NPI 1528310323
  Medicare reassignment NPD
• Hilton Head Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Hilton Head Island, SC
  • NPI 1326047176
  Medicare reassignment NPD
• Hospital Medicine Services of FL, LLC

  • Hospitalist Physician
  • Aventura, FL
  • NPI 1710684857
  Medicare reassignment NPD
• Paragon Contracting Services LLC

  • Emergency Medicine Physician
  • Birmingham, AL
  • NPI 1225071459
  Medicare reassignment NPD
• Emergencymd

  • General Practice Physician
  • Greenville, SC
  • NPI 1619383791
  NPD
• Hilton Head Emergency Physicians, Inc.

  • Emergency Medicine Physician
  • Hardeeville, SC
  • NPI 1265680391
  NPD
• Musc Community Physicians

  • Rural Health Clinic/Center
  • Bowman, SC
  • NPI 1225735772
  NPD
• Musc Community Physicians

  • Family Medicine Physician
  • Bamberg, SC
  • NPI 1992383145
  NPD

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

• Galencare, Inc.

  • General Acute Care Hospital
  • Brandon, FL
  • NPI 1669427258
  Care Compare affiliation
• Medical University Hospital Authority

  • General Acute Care Hospital
  • Charleston, SC
  • NPI 1073605879
  Care Compare affiliation
• Medical University Hospital Authority

  • Rehabilitation Hospital
  • Orangeburg, SC
  • NPI 1154020147
  Care Compare affiliation
• Medical University Hospital Authority

  • General Acute Care Hospital
  • Charleston, SC
  • NPI 1659435840
  Care Compare affiliation
• Medical University Hospital Authority

  • Psychiatric Hospital
  • Orangeburg, SC
  • NPI 1669171740
  Care Compare affiliation
• Medical University Hospital Authority

  • General Acute Care Hospital
  • Orangeburg, SC
  • NPI 1710683354
  Care Compare affiliation
• Medical University Hospital Authority

  • General Acute Care Hospital
  • Orangeburg, SC
  • NPI 1770280299
  Care Compare affiliation
• Sarasota Doctors Hospital Inc

  • General Acute Care Hospital
  • Sarasota, FL
  • NPI 1003862053
  Care Compare affiliation
• West Florida - MHT LLC

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1871935072
  Care Compare affiliation

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

{
    "created_epoch": "1368662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1629414701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035812",
            "telephone_number": "704-355-2171"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 E Wood St",
            "address_purpose": "LOCATION",
            "city": "Spartanburg",
            "state": "SC",
            "postal_code": "293033040",
            "country_code": "US",
            "telephone_number": "864-560-7025",
            "fax_number": "864-560-7388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "PATRICK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-16",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "39300",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2016-00882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pjackson178854@direct-srhs.et0939.epichosted.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "pjackson178854@direct-srhs.et0939.epichosted.com",
            "address_1": "101 E Wood St",
            "city": "Spartanburg",
            "state": "SC",
            "country_code": "US",
            "postal_code": "293033040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Logan J Jackson, MD
• Malaka Baharah Jackson, M.D.
• Natalie Ann Jackson
• Nola Ann Jackson
• Pamela Carol Jackson, NP
• Porshai Juanice Jackson
• Quineka Jackson
• Rebecca Kemp Jackson, MS, LCAS-A
• Reginald Jackson
• Robert Jackson

• Emergency Medicine Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Emergency Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; 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.
• 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.