Benjamin Jackson, DO

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

2021-01092 Issued in NC

Practice address

709 Green Valley Rd
Greensboro, NC 27408-7019

Phone

(336) 890-2530

NPI assigned

Apr 4, 2018

Last updated

Jul 25, 2022By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Sports MedicineAlso: Family Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Moses Cone Medical Services IncGroup PAC ID 2769395458, 214 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Moses H. Cone Memorial Hospital, the Hospital, Greensboro, NC, CCN 340091

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

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.

• Moses Cone Medical Services, Inc.

  • Internal Medicine Physician
  • Greensboro, NC
  • NPI 1427095249
  Medicare reassignment Care Compare group NPD
• Moses Cone Medical Services, Inc.

  dba Western Rockingham Family Medicine

  • Family Medicine Physician
  • Madison, NC
  • NPI 1629376363
  NPD
• Greensboro Radiology, PA

  • Diagnostic Radiology Physician
  • Greensboro, NC
  • NPI 1821035999
  NPD (past)

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

• The Moses H. Cone Memorial Hospital Operating Corporation

  • General Acute Care Hospital
  • Greensboro, NC
  • NPI 1477591055
  Care Compare affiliation

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

{
    "created_epoch": "1522800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1639675044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W 27TH ST",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "283583075",
            "telephone_number": "910-272-1478",
            "fax_number": "910-738-3730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 GREEN VALLEY RD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274087019",
            "telephone_number": "336-890-2530"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "730 Oakridge Blvd",
            "address_purpose": "LOCATION",
            "city": "Lumberton",
            "state": "NC",
            "postal_code": "283582324",
            "country_code": "US",
            "telephone_number": "910-738-2662",
            "fax_number": "910-738-3730",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-04",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NC",
            "license": "2021-01092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mahamad Jabbi, LCSWA
• Jack of All Stixx
• Jack Register & Associates PLLC
• Harold N Jacklin, MD
• Ariel Jackson
• Carley Jackson
• Carswell Hoots Jackson, MD
• Chelsea Nicole Jackson, FNP-C
• Christine L Jackson
• Delphia Dent Jackson, CNA

• Sports Medicine (Family Medicine) Physician in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Sports Medicine (Family Medicine) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; 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.