Active NPI
Bernice D. Jackson, M.D.
- Cardiovascular Disease Physician
- Washington, DC
National Provider Identifier
1639195407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- MD17118
- Practice address
- 1160 Varnum St NE
Suite 314
Washington, DC 20017-2107 - Phone
- (202) 269-9249
- Fax
- (202) 269-9271
- NPI assigned
- Jul 14, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | MD17118 | DC | Primary |
Addresses
Primary practice location
1160 Varnum St NE
Suite 314
Washington, DC 20017-2107
Mailing address
15009 Notley Rd
Silver Spring, MD 20905-7438
Phone (202) 269-9429
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 027063100 | Medicaid | DC | |
| 579232 | Other | DC | ALLIANCE |
| 6631 0001 | Other | DC | BC BS DC |
| AETNA | Other | DC | 2005550 |
| 63833701 | Other | MD | BCBS MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080223000091 | DC | Practitioner - Cardiovascular Disease (Cardiology) | 8224112602 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295568000000",
"number": "1639195407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15009 NOTLEY RD",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209057438",
"telephone_number": "202-269-9429",
"fax_number": "202-269-9271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1160 VARNUM ST NE",
"address_2": "SUITE 314",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200172107",
"telephone_number": "202-269-9249",
"fax_number": "202-269-9271"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "BERNICE",
"middle_name": "D.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-14",
"last_updated": "2011-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "DC",
"license": "MD17118",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "027063100",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALLIANCE",
"identifier": "579232",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC BS DC",
"identifier": "6631 0001",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "2005550",
"identifier": "AETNA",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MD",
"identifier": "63833701",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2011; 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.