Individual provider Active NPI

Mashira Denisha Jackson-Gallegos, MD

  • Family Medicine Physician
  • Tampa, FL
National Provider Identifier
1639373509
Registry record updated Jan 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME 108584 Issued in FL
Practice address
8751 N 30TH St
Tampa, FL 33604-2213
Phone
(813) 980-2422
Fax
(813) 305-2642
NPI assigned
Jun 13, 2007
Last updated
Jan 31, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 141452 NC
Family Medicine Physician 207Q00000X ME 108584 FL Primary

Addresses

Primary practice location

8751 N 30TH St
Tampa, FL 33604-2213

Mailing address

8751 N 30TH St
Tampa, FL 33604-2213
Phone (813) 980-2422

Other names 1

  • Dr. Mashira Denisha Jackson Former name

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20110503000344 FL Practitioner - Family Practice 7416132659 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Morehouse School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Top Physicians Group IncGroup PAC ID 0244497154, 2 clinicians

Practice addresses (Care Compare)

8751 N 30TH St
Tampa, FL 33604-2213
Phone (813) 980-2422

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME 108584FLMDFamily Medicine Physician
141452NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Top Physicians Group, Inc CurrentSince Dec 1, 2024 Accepting new patients
Gainesville Physicians LLC Family Medicine Past Accepting new patients

Locations

8751 N 30th St
Tampa, FL 33604
Phone (813) 980-2422

Networks

  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: mashira.jacksongallegosmd@direct.mybaycare.org
  • Direct secure messaging: mashira.jacksongalleogs@322291431899140.direct.elationemr.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738281600000",
    "number": "1639373509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8751 N 30TH ST",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336042213",
            "telephone_number": "813-980-2422",
            "fax_number": "813-305-2642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8751 N 30TH ST",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336042213",
            "telephone_number": "813-980-2422",
            "fax_number": "813-305-2642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON-GALLEGOS",
        "first_name": "MASHIRA",
        "middle_name": "DENISHA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-13",
        "last_updated": "2025-01-31",
        "certification_date": "2025-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "141452",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME 108584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MASHIRA",
            "last_name": "JACKSON",
            "middle_name": "DENISHA",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.