NPIMap

Individual provider Active NPI

David Lance Jackson, MD

  • Family Medicine Physician
  • Akron, OH
National Provider Identifier
1659473791
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OH-35055410 Issued in OH
Practice address
3529 Fortuna Dr
Akron, OH 44312-5282
Phone
(330) 644-0022
Fax
(330) 644-0328
NPI assigned
Sep 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OH-35055410 OH Primary

Addresses

Primary practice location

3529 Fortuna Dr
Akron, OH 44312-5282

Mailing address

3529 Fortuna Dr
Akron, OH 44312-5282
Phone (330) 644-0022

Other identifiers 1

IdentifierTypeStateIssuer
0686066MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120327000689 OH Practitioner - Family Practice 6608035571 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Northeastern Ohio University College of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Partners Physician GroupGroup PAC ID 4183529340, 409 clinicians
Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

3529 Fortuna Dr
Akron, OH 44312-5282
Phone (330) 644-0222

9500 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 636-1768

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions13
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OH-35055410OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Partners Physician Group Family Medicine CurrentSince May 1, 2021 Accepting new patients
Partners Physician Group CurrentSince May 1, 2021 Accepting new patients
Partners Physician Group Family Medicine Past Accepting new patients

Locations

224 W Exchange St
Ste 160
Akron, OH 44302
Phone (330) 344-6505

1 Akron General Ave
Akron, OH 44307
Phone (330) 344-5760

3529 Fortuna Dr
Green, OH 44312
Phone (330) 644-0022

Organizations & group practices 5

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 6

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": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659473791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3529 FORTUNA DR",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443125282",
            "telephone_number": "330-644-0022",
            "fax_number": "330-644-0328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3529 FORTUNA DR",
            "city": "AKRON",
            "state": "OH",
            "postal_code": "443125282",
            "telephone_number": "330-644-0022",
            "fax_number": "330-644-0328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DAVID",
        "middle_name": "LANCE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "OH-35055410",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0686066",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Akron, OH

Sources for this page

Verify at the official NPI Registry.