Horace J Jackson, MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

0101035670 Issued in VA

Practice address

505 W Leigh Street
Suite 207
Richmond, VA 23220

Phone

(804) 788-0556

Fax

(804) 788-1141

NPI assigned

Jul 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in VA

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

GastroenterologyAlso: Internal Medicine

Education

Howard University College of Medicine, 1976

Medicare assignment

May accept Medicare assignment

Group practices

Clark Alliance Services IncGroup PAC ID 8325475981, 27 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bon Secours Memorial Regional Medical Center Hospital, Mechanicsville, VA, CCN 490069
• Bon Secours Richmond Community Hospital Hospital, Richmond, VA, CCN 490094
• Vcu Health Tappahannock Hospital Hospital, Tappahannock, VA, CCN 490084
• Select Speciality Hospital - Richmond Inc Long-term care hospital, Richmond, VA, CCN 492009

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/5784/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 and National Provider Directory roles.

• Clark Alliance Services Inc

  • Internal Medicine Physician
  • Alexandria, VA
  • NPI 1952892028
  Medicare reassignment Care Compare group NPD
• Vibra Physicians LLC

  • Hospitalist Physician
  • Johnstown, CO
  • NPI 1659705424

  VA

  Medicare reassignment NPD
• Horace J Jackson MD PC

  • Gastroenterology Physician
  • Warsaw, VA
  • NPI 1144466368
  NPD (past) Authorized official
• Horace J Jackson MD PC

  • Gastroenterology Physician
  • Richmond, VA
  • NPI 1851324958
  NPD (past) Authorized official
• Lei S. Charlton, M.D., P.C.

  • Internal Medicine Physician
  • Richmond, VA
  • NPI 1962716928
  NPD (past)

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

• Bon Secours Memorial Regional Medical Center LLC

  dba Memorial Regional Medical Center

  • General Acute Care Hospital
  • Mechanicsville, VA
  • NPI 1912969064
  Care Compare affiliation
• Bon Secours-Richmond Community Hospital LLC

  dba Bon Secours - Richmond Community Hospital

  • General Acute Care Hospital
  • Richmond, VA
  • NPI 1366404428
  Care Compare affiliation
• Select Specialty Hospital - Richmond, Inc.

  • Long Term Care Hospital
  • Richmond, VA
  • NPI 1952004657

  Long-term care hospital

  Care Compare affiliation
• Vcu Health Tappahannock Hospital

  • General Acute Care Hospital
  • Tappahannock, VA
  • NPI 1760580757
  Care Compare affiliation

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188345600000",
    "number": "1669407003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 W LEIGH STREET",
            "address_2": "SUITE 207",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23220",
            "telephone_number": "804-788-0556",
            "fax_number": "804-788-1141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 W LEIGH STREET",
            "address_2": "SUITE 207",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23220",
            "telephone_number": "804-788-0556",
            "fax_number": "804-788-1141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "HORACE",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2007-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "VA",
            "license": "0101035670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BS",
            "identifier": "006954",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006049656",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah June Jackson, BCBA, LBA
• Destinee Monet Jackson
• Diane Jackson, LCSW
• Elizabeth Jackson
• Henry Edward Jackson
• Jalin C Jackson
• Janai Cassandra Jackson
• Kathryn Jackson, LCSW
• Kwame Jackson
• Latrelle Jackson, PHD

• Gastroenterology Physician in Richmond, VA
• Providers in Richmond, VA by specialty
• Gastroenterology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2007; 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.