Active NPI
Deidrya Antoinette Elizabeth Jackson, MD MPH
- Glaucoma Specialist (Ophthalmology) Physician
- Boston, MA
National Provider Identifier
1649658931
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Glaucoma Specialist (Ophthalmology) Physician
- License
- 278459
- Practice address
- 800 Washington St
Boston, MA 02111-1552 - Phone
- (617) 636-5000
- NPI assigned
- May 7, 2015
- 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 |
|---|---|---|---|---|
| Glaucoma Specialist (Ophthalmology) Physician | 207WX0009X | 278459 | MA | Primary |
Addresses
Primary practice location
800 Washington St
Boston, MA 02111-1552
Mailing address
800 Washington St
Boston, MA 02111-1552
Phone (617) 636-5000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 278459 | MA | MD | Glaucoma Specialist (Ophthalmology) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558396800000",
"number": "1649658931",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 WASHINGTON ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021111552",
"telephone_number": "617-636-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 WASHINGTON ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021111552",
"telephone_number": "617-636-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "DEIDRYA",
"middle_name": "ANTOINETTE ELIZABETH",
"name_prefix": "Dr.",
"credential": "MD MPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-05-07",
"last_updated": "2019-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "207WX0009X",
"taxonomy_group": "",
"desc": "Ophthalmology, Glaucoma Specialist",
"state": "MA",
"license": "278459",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2019; 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.