Rebecca Yvette Jackson, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F11200588 Issued in MD

Practice address

2520 N Charles St
Baltimore, MD 21218-4669

Phone

(410) 702-0510

NPI assigned

Dec 5, 2020

Sex

Female

Sole proprietor

Yes

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 MD, DC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lifestream Health CenterGroup PAC ID 4284870072, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rebecca.jackson.1@20459.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/25311/brand/1/csg/1/fhir/r4

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.

• Family Affair Care, LLC

  • General Practice Registered Nurse
  • Reisterstown, MD
  • NPI 1427623750
  Medicare reassignment NPD Authorized official
• Lifestream Health Center

  • Specialist
  • Bowie, MD
  • NPI 1881728996
  Medicare reassignment Care Compare group NPD
• Medstar Urgent Care LLC

  dba MedStar PromptCare

  • Urgent Care Clinic/Center
  • Baltimore, MD
  • NPI 1902175870
  Medicare reassignment NPD
• Medstar Urgent Care, LLC

  dba MedStar PromptCare-Wheaton

  • Urgent Care Clinic/Center
  • Wheaton, MD
  • NPI 1871843409

  DC

  Medicare reassignment NPD
• Prestige Healthcare Resources Inc.

  • Adult Mental Health Clinic/Center
  • Bladensburg, MD
  • NPI 1144516824

  DC

  Medicare reassignment NPD
• Family Affair Care, LLC

  • Primary Care Clinic/Center
  • Towson, MD
  • NPI 1114729472
  NPD Authorized official
• Lgtula,LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Baltimore, MD
  • NPI 1053156166
  NPD Authorized official
• Medstar Urgent Care LLC

  • General Practice Physician
  • Lexington Park, MD
  • NPI 1275410474
  NPD
• Medstar Urgent Care LLC

  dba MMG Urgent Care

  • Urgent Care Clinic/Center
  • Baltimore, MD
  • NPI 1942623319
  NPD
• Prestige Healthcare Resources Inc.

  • Community/Behavioral Health Agency
  • Largo, MD
  • NPI 1215691738
  NPD
• Prestige Healthcare Resources Inc.

  • Addiction (Substance Use Disorder) Counselor
  • Largo, MD
  • NPI 1326615089
  NPD

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

{
    "created_epoch": "1607126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703030400000",
    "number": "1649876749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 N CHARLES ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212184669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 N CHARLES ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212184669",
            "telephone_number": "410-702-0510"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "705 E Patapsco Ave # 2",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "MD",
            "postal_code": "212251934",
            "country_code": "US",
            "telephone_number": "240-394-3453",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "REBECCA",
        "middle_name": "YVETTE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-05",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R160571",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "F11200588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pattie D. Jackson, LCSW-C
• Phillip Anthony Jackson Jr., CRNP
• Prudence Jackson, MD
• Rachel Allison Jackson
• Rebecca Ann Jackson
• Rosa Jackson, LGSW
• Sadhana Jackson, MD
• Samantha Lachelle Jackson, LCPC
• Selah Jackson
• Shala Jackson

• Family Nurse Practitioner in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Family Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; 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.